Revised Heart Transplant Wait List Criteria Criticized


NEW ORLEANS — Obesity should not be considered a relative contraindication to heart transplantation, contrary to last year's revised International Society for Heart and Lung Transplantation recommendations, Dr. Mark J. Russo said at the annual meeting of the American College of Cardiology.

He presented an analysis of nearly 19,000 U.S. first-time adult heart transplant recipients who underwent the procedure in 1995–2005. The data, from the United Network for Organ Sharing (UNOS) registry, showed the obese subgroup had a 10-year posttransplant survival rate similar to that of overweight patients and significantly better than severely obese patients with a BMI between 35 and less than 40 kg/m

Patients who were normal weight at transplantation had the best median long-term survival, well in excess of 10 years compared with about 6.5 years for the severely obese. Long-term survival of overweight and obese recipients was only slightly less than for the normal weight, and that difference wasn't clinically meaningful.

“The data support transplanting patients with a BMI up to 35 kg/m

“When the committee developed its recommendation, the members noted that it was supported only by expert opinion based upon the best available data. We believe that we've now provided data better than what was available at the time the recommendations were made and hope that future recommendations would reflect our findings,” the cardiothoracic surgeon said.

The transplant society committee made no recommendation regarding underweight patients. Yet cachexia is a powerful marker of poor prognosis in end-stage heart failure, and the UNOS data showed the 1-year survival of underweight recipients was significantly worse than normal, overweight, or obese recipients. In fact, it approximated the 1-year survival of severely or morbidly obese patients, he noted.

'The [UNOS registry] data support transplanting patients with a BMI up to 35 kg/m

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