Rollins Zach, Christopher Kwon Ye In, Gardner Graham, Bashian Elizabeth, Ambrosio Matthew, Tchoukina Inna F, Shah Keyur, Rajeev Rahul, Chery Josue, Kasirajan Vigneshwar, Hashmi Zubair A
Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Va.
Department of Biostatistics, School of Population Health, Virginia Commonwealth University, Richmond, Va.
JTCVS Open. 2025 Mar 19;25:253-263. doi: 10.1016/j.xjon.2025.02.022. eCollection 2025 Jun.
Obesity and older age have both been identified as risk factors for a worse long-term prognosis after heart transplantation. We sought to determine the 5-year outcomes for heart transplant patients with high-risk body mass index (BMI) >30 (HRB), high-risk age >70 years (HRA), or both (HRAB) as compared with recipients with normal risk (NR) in the modern era.
Records of isolated heart transplants in the United States from 2014 to 2023 were obtained for adults older than 18 years. BMI and age cut-off was identified on spline analysis. Survival curves were built for overall survival using a Kaplan-Meier method, with a log-rank test used to test for differences between groups. Risk adjusted Cox regression was performed on variables potentially influencing overall survival.
Between 2014 and 2023, there were 15,839 NR; 869 HRA; 8187 HRB; and 202 HRAB patients. There was a significant difference in overall survival by Kaplan-Meier evaluation between the 4 groups, with worse survival in the high-risk groups ( < .001). The hazard ratio for mortality in the HRB, HRA, and HRAB groups was 1.21, 1.23, and 1.72, respectively ( < .05). However, even recipients in the HRAB group had 5-year survival rates of 66.8%.
Overall survival is worse in recipients in the HRA, HRB, or HRAB groups than in recipients in the NR group but similar between patients with isolated BMI >30 or age >70 years. Patients with both increased BMI >30 and age >70 years had the worst overall survival. However, the 5-year survival even for HRAB suggests the value of transplantation even if patients are at high risk.
肥胖和高龄均已被确定为心脏移植后长期预后较差的危险因素。我们试图确定现代时代体重指数（BMI）>30的高风险（HRB）、年龄>70岁的高风险（HRA）或两者兼具（HRAB）的心脏移植患者与正常风险（NR）受者相比的5年结局。
获取2014年至2023年美国18岁以上成年人单纯心脏移植的记录。通过样条分析确定BMI和年龄的临界值。使用Kaplan-Meier方法构建总生存曲线，采用对数秩检验来检验组间差异。对可能影响总生存的变量进行风险调整的Cox回归分析。
2014年至2023年期间，有15839例NR患者；869例HRA患者；8187例HRB患者；以及202例HRAB患者。通过Kaplan-Meier评估，4组之间的总生存存在显著差异，高风险组的生存情况较差（P<0.001）。HRB、HRA和HRAB组的死亡风险比分别为1.21、1.23和1.72（P<0.05）。然而，即使是HRAB组的受者，其5年生存率也达到了66.8%。
HRA、HRB或HRAB组受者的总生存情况比NR组受者差，但BMI>30或年龄>70岁的患者之间情况相似。BMI>30且年龄>70岁的患者总生存情况最差。然而，即使是HRAB患者的5年生存率也表明，即使患者处于高风险，移植仍有价值。
