Post-Transplantation Body Mass Index in Heart Transplant Recipients: Determinants and Consequences I. Milaniaka,b,*, P. Przybyłowskia,c, K. Wierzbickia,c, and J. Sadowskia,c a Cardiovascular Surgery and Transplantology Department, John Paul II Hospital; bAndrzej Frycz Modrzewski Krakow University, Faculty of Health and Medical Science; and cCollegium Medicum UJ, Krakow, Poland
ABSTRACT Background. Heart transplantation (HTx) is an important treatment for end-stage chronic heart failure. After HTx, recipients frequently become obese. Gaining weight measured by body mass index (BMI) has been reported as a common phenomenon for patients before and after solid organ transplantation, becoming specifically significant for the long-term follow up after organ transplantation. In the long term following HTx, overweight and obesity may lead to increased risk of cardiovascular complications, developing metabolic syndromeea topic well documented in previous studies. Aim. The aims of this study were to calculate the BMI in patients after HTx with follow up in our center and to assess potential predictors for overweight and obesity as well as their consequences. Methods. A complete assessment of the BMI among all available heart transplant (HT) recipients (n ¼ 169) was performed. Data were retrieved from patients’ charts. Data were statistically analyzed. Results. The sample mean age was 55.12 13.34 years, mean years since transplantation being 10.70 5.26 years and the majority of study subjects were males (76.33%). Overall BMI was mean 26.33 3.79. Based on the World Health Organization (WHO) classification, 32.54% were normal, 46.74% were overweight, and 18.34% were obese. We did not observe a statistical difference between BMI before and after transplantation, between immunosuppressive protocol, and receipt of steroids. We observed an association between BMI and level of fasting glucose (r ¼ 0.35; P < .05) and difference between BMI and gender as well as the presence of cardiovascular diseases. Conclusions. Overweight and obesity after HTx are common and reflect a risk factor for cardiac allograft vasculopathy and other cardiovascular diseases as well as metabolic syndrome among HT recipients.
A
2012 report from the National Center for Health Statistics indicated that 35.7% of adults (about 78 million people) are obese, defined as a body mass index (BMI) of 30 [1]. According to guidelines from the International Society for Heart and Lung Transplantation, pretransplantation BMI >30 kg/m2 is associated with poor outcome after cardiac transplantation. For obese patients, it is reasonable to recommend weight loss to achieve a BMI of 25 kg/m2 was observed in more than 80% of the study population, with raised systolic blood pressure (BP) in 42% and diabetes in more than a quarter of subjects [15]. These findings point the way to a hypothesis that interventions specifically designed to prevent weight gain might influence outcome following HTx. Data from our experience show that health professionals should encourage healthy eating and exercise and continue to screen for obesity, hypertension, dyslipidemia, and diabetes.
REFERENCES
Fig 1. BMI (%) before and after HTx (P > .05).
[1] Ogden CL, Carroll MD, Kit BK. Prevalence of obesity in the United States, 2009-2010. NCHS Data Brief, No 82 2012. National Center for Health Statistics. [2] Mehra MR, Kobashigawa J, Starling R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidatesd2006. J Heart Lung Transplant 2006;25(9):1024e41. [3] Clark AL, et al. Heart transplantation in heart failure: The prognostic importance of body mass index at time of surgery and subsequent weight changes. Eur J Heart Fail 2007;9:839e44.
BMI IN HT RECIPIENTS [4] Lund LH, Edwards LB, Kucheryavaya AY. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Official Adult Heart Transplant Reportd2013; Focus Theme: Age. The Journal of Heart and Lung Transplantation 2013;32(10):951e64. [5] Pethig K, Klauss V, Heublein B. Progression of cardiac allograft vascular disease as assessed by serial intravascular ultrasound: correlation to immunological and non-immunological risk factors. Heart 2000;84(5):494e8. [6] Costanzo MR, Dipchand A, Starling R. The International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010;29(8): 914e56. [7] Kashem MA, Fitzpatrick JT, Nikolaidis L. BMI effects on heart transplant survival: single institution vs. national experience. J Heart Lung Transplant 2009;28:116. [8] Obesity preventing and managing the global epidemic. Report of WHO Consultation on Obesity. Geneva 3-5 June 1997 WHO/NUT/NCD. Geneva 1998, 276. [9] Grady KL, Costanzo-Nordin MR, Herold LS, et al. Obesity and hyperlipidemia after heart transplantation. J Heart Lung Transplant 1991;10:449e54.
2847 [10] Lake KD, Reutzel TJ, Pritzker MR, et al. The impact of steroid withdrawal on the development of lipid abnormalities and obesity in heart transplant recipients. J Heart Lung Transplant 1993;12:580e90. [11] Wiliams JJ, Lundh LH, Kunavarapu C, et al. Excessive weight gain in cardiac transplant recipients. J Heart Lung Transplant 2006;25(1):36e41. [12] Grady KL, Naftel D, Pamboukian SV, et al. Post-operative obesity and cachexia are risk factors for morbidity and mortality after heart transplant: multi-institutional study of post-operative weight change. J Heart Lung Transplant 2005;24(9):1424e30. [13] Russo MJ, Hong KN, Davies RR, et al. The effect of body mass index on survival following heart transplantation: do outcomes support consensus guidelines? Ann Surg 2010;251(1):144e52. [14] de Oliveira Carlos DM, Clineu Queiroz França F, de Sousa Neto JD. Impact of weight variation on the metabolic stability of cardiac transplant patients in the state of Ceara. Arq Bras Cardiol 2008;90(4):268e73. [15] Cristiano HY, Lee GA, Bergin JP. Cardiovascular risk factors associated with cardiac allograft vasculopathy following cardiac transplantation: a longitudinal follow-up. Transplant J Australasia 2012;21(3):16.
ABSTRACT Background. Heart transplantation (HTx) is an important treatment for end-stage chronic heart failure. After HTx, recipients frequently become obese. Gaining weight measured by body mass index (BMI) has been reported as a common phenomenon for patients before and after solid organ transplantation, becoming specifically significant for the long-term follow up after organ transplantation. In the long term following HTx, overweight and obesity may lead to increased risk of cardiovascular complications, developing metabolic syndromeea topic well documented in previous studies. Aim. The aims of this study were to calculate the BMI in patients after HTx with follow up in our center and to assess potential predictors for overweight and obesity as well as their consequences. Methods. A complete assessment of the BMI among all available heart transplant (HT) recipients (n ¼ 169) was performed. Data were retrieved from patients’ charts. Data were statistically analyzed. Results. The sample mean age was 55.12 13.34 years, mean years since transplantation being 10.70 5.26 years and the majority of study subjects were males (76.33%). Overall BMI was mean 26.33 3.79. Based on the World Health Organization (WHO) classification, 32.54% were normal, 46.74% were overweight, and 18.34% were obese. We did not observe a statistical difference between BMI before and after transplantation, between immunosuppressive protocol, and receipt of steroids. We observed an association between BMI and level of fasting glucose (r ¼ 0.35; P < .05) and difference between BMI and gender as well as the presence of cardiovascular diseases. Conclusions. Overweight and obesity after HTx are common and reflect a risk factor for cardiac allograft vasculopathy and other cardiovascular diseases as well as metabolic syndrome among HT recipients.
A
2012 report from the National Center for Health Statistics indicated that 35.7% of adults (about 78 million people) are obese, defined as a body mass index (BMI) of 30 [1]. According to guidelines from the International Society for Heart and Lung Transplantation, pretransplantation BMI >30 kg/m2 is associated with poor outcome after cardiac transplantation. For obese patients, it is reasonable to recommend weight loss to achieve a BMI of 25 kg/m2 was observed in more than 80% of the study population, with raised systolic blood pressure (BP) in 42% and diabetes in more than a quarter of subjects [15]. These findings point the way to a hypothesis that interventions specifically designed to prevent weight gain might influence outcome following HTx. Data from our experience show that health professionals should encourage healthy eating and exercise and continue to screen for obesity, hypertension, dyslipidemia, and diabetes.
REFERENCES
Fig 1. BMI (%) before and after HTx (P > .05).
[1] Ogden CL, Carroll MD, Kit BK. Prevalence of obesity in the United States, 2009-2010. NCHS Data Brief, No 82 2012. National Center for Health Statistics. [2] Mehra MR, Kobashigawa J, Starling R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidatesd2006. J Heart Lung Transplant 2006;25(9):1024e41. [3] Clark AL, et al. Heart transplantation in heart failure: The prognostic importance of body mass index at time of surgery and subsequent weight changes. Eur J Heart Fail 2007;9:839e44.
BMI IN HT RECIPIENTS [4] Lund LH, Edwards LB, Kucheryavaya AY. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Official Adult Heart Transplant Reportd2013; Focus Theme: Age. The Journal of Heart and Lung Transplantation 2013;32(10):951e64. [5] Pethig K, Klauss V, Heublein B. Progression of cardiac allograft vascular disease as assessed by serial intravascular ultrasound: correlation to immunological and non-immunological risk factors. Heart 2000;84(5):494e8. [6] Costanzo MR, Dipchand A, Starling R. The International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010;29(8): 914e56. [7] Kashem MA, Fitzpatrick JT, Nikolaidis L. BMI effects on heart transplant survival: single institution vs. national experience. J Heart Lung Transplant 2009;28:116. [8] Obesity preventing and managing the global epidemic. Report of WHO Consultation on Obesity. Geneva 3-5 June 1997 WHO/NUT/NCD. Geneva 1998, 276. [9] Grady KL, Costanzo-Nordin MR, Herold LS, et al. Obesity and hyperlipidemia after heart transplantation. J Heart Lung Transplant 1991;10:449e54.
2847 [10] Lake KD, Reutzel TJ, Pritzker MR, et al. The impact of steroid withdrawal on the development of lipid abnormalities and obesity in heart transplant recipients. J Heart Lung Transplant 1993;12:580e90. [11] Wiliams JJ, Lundh LH, Kunavarapu C, et al. Excessive weight gain in cardiac transplant recipients. J Heart Lung Transplant 2006;25(1):36e41. [12] Grady KL, Naftel D, Pamboukian SV, et al. Post-operative obesity and cachexia are risk factors for morbidity and mortality after heart transplant: multi-institutional study of post-operative weight change. J Heart Lung Transplant 2005;24(9):1424e30. [13] Russo MJ, Hong KN, Davies RR, et al. The effect of body mass index on survival following heart transplantation: do outcomes support consensus guidelines? Ann Surg 2010;251(1):144e52. [14] de Oliveira Carlos DM, Clineu Queiroz França F, de Sousa Neto JD. Impact of weight variation on the metabolic stability of cardiac transplant patients in the state of Ceara. Arq Bras Cardiol 2008;90(4):268e73. [15] Cristiano HY, Lee GA, Bergin JP. Cardiovascular risk factors associated with cardiac allograft vasculopathy following cardiac transplantation: a longitudinal follow-up. Transplant J Australasia 2012;21(3):16.
