BackgroundPatients with obesity and advanced heart failure face unique challenges on the path to heart transplantation. There are limited data on waitlist and transplantation outcomes in this population. We aimed to evaluate the impact of obesity on heart transplantation outcomes, and to investigate the effects of the new organ procurement and transplantation network allocation system in this population.Methods and ResultsThis cohort study of adult patients listed for heart transplant used the United Network for Organ Sharing database from January 2006 to June 2020. Patients were stratified by body mass index (BMI) (18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and 40–55 kg/m²). Recipient characteristics and donor characteristics were analyzed. Outcomes analyzed included transplantation, waitlist death, and posttransplant death. BMI 18.5 to 24.9 kg/m² was used as the reference compared with progressive BMI categories. There were 46 645 patients listed for transplantation. Patients in higher BMI categories were less likely to be transplanted. The lowest likelihood of transplantation was in the highest BMI category, 40 to 55 kg/m² (hazard ratio [HR], 0.19 [0.05–0.76]; P=0.02). Patients within the 2 highest BMI categories had higher risk of posttransplantation death (HR, 1.29; P<0.001 and HR, 1.65; P<0.001, respectively). Left ventricular assist devices among patients in obese BMI categories decreased after the allocation system change (P<0.001, all). After the change, patients with obesity were more likely to undergo transplantation (BMI 30–35 kg/m²: HR, 1.31 [1.18–1.46], P<0.001; BMI 35–55 kg/m²: HR, 1.29 [1.06–1.58]; P=0.01).ConclusionsThere was an inverse relationship between BMI and likelihood of heart transplantation. Higher BMI was associated with increased risk of posttransplant mortality. Patients with obesity were more likely to undergo transplantation under the revised allocation system.

中文翻译：

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肥胖对心脏移植结果的影响

背景肥胖和晚期心力衰竭患者在心脏移植的道路上面临着独特的挑战。关于该人群的候补名单和移植结果的数据有限。我们旨在评估肥胖对心脏移植结果的影响，并调查新的器官采购和移植网络分配系统在该人群中的影响。方法和结果这项对列入心脏移植名单的成年患者的队列研究使用了器官联合网络共享数据库从 2006 年 1 月到 2020 年 6 月。患者按体重指数 (BMI)（18.5–24.9、25–29.9、30–34.9、35–39.9 和 40–55 kg/m2）^分层）。接受者特征和捐赠者特征进行了分析。分析的结果包括移植、候补名单死亡和移植后死亡。BMI 18.5 至 24.9 kg/m ²被用作与进行性 BMI 类别相比的参考。有 46 645 名患者被列入移植名单。BMI 较高的患者不太可能接受移植。移植可能性最低的是最高 BMI 类别，40 至 55 kg/m ²（风险比 [HR]，0.19 [0.05–0.76]；P = 0.02）。2 个最高 BMI 类别的患者移植后死亡风险更高（HR，1.29；P <0.001 和 HR，1.65；P<0.001，分别）。分配系统改变后，肥胖 BMI 类别患者的左心室辅助装置减少（P <0.001，全部）。改变后，肥胖患者更有可能接受移植（BMI 30-35 kg/m ² : HR, 1.31 [1.18-1.46], P <0.001; BMI 35-55 kg/m ² : HR, 1.29 [1.06] –1.58]; P =0.01).结论BMI与心脏移植的可能性呈负相关。较高的 BMI 与移植后死亡率的增加有关。在修订后的分配系统下，肥胖患者更有可能接受移植。