HHS Public Access Author manuscript Author Manuscript
Heart Lung. Author manuscript; available in PMC 2017 July 01. Published in final edited form as: Heart Lung. 2016 ; 45(4): 298–304. doi:10.1016/j.hrtlng.2016.03.005.
Clinical outcomes in overweight heart transplant recipients Anne Jalowiec, PhD, RNa,*, Kathleen L. Grady, PhD, RNb,c, and Connie White–Williams, PhD, RNd,e aSchool
of Nursing, Loyola University of Chicago, Chicago, IL, USA
bCenter
for Heart Failure, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
Author Manuscript
cFeinberg dCenter
School of Medicine, Northwestern University, Chicago, IL, USA
for Nursing Excellence, University of Alabama at Birmingham Hospital, Birmingham, AL,
USA eUniversity
of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
Abstract Background—There is a paucity of research examining the impact of patient weight after heart transplant (HT) on multiple clinical outcomes.
Author Manuscript
Objectives—The purpose of this study was to compare 9 clinical outcomes in 2 groups of HT recipients (N = 347) from 2 hospitals in the midwestern and southern United States, based on their mean body mass index (BMI) during the first 3 years post-HT, and to identify risk factors for mortality. Methods—The sample was divided into 2 groups: Group 1: 108 non-overweight patients (BMI 20 years) following heart transplantation. J Cardiovasc Surg (Torino). 2012; 53:677–684. 51. Delgado JF, Crespo-Leiro MG, Gomez-Sanchez MA, Paniagua MJ, Gonzalez-Vilchez F, et al. Risk factors associated with moderate-to-severe renal dysfunction among heart transplant patients: results from the CAPRI study. Clin Transplant. 2010; 24:E194–E200. [PubMed: 20597926] 52. Hamour IM, Omar F, Lyster HS, Palmer A, Banner NR. Chronic kidney disease after heart transplantation. Nephrol Dial Transplant. 2009; 24:1655–1662. [PubMed: 19168463] 53. Bedanova H, Ondrasek J, Cerny J, Orban M, Spinarova L, et al. Impact of diabetes mellitus on survival rates after heart transplantation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009; 153:283–287. [PubMed: 20208968] 54. Nieuwenhuis MG, Kirkels JH. Predictability and other aspects of post-transplant diabetes mellitus in heart transplant recipients. J Heart Lung Transplant. 2001; 20:703–708. [PubMed: 11448794] 55. Ye X, Kuo HT, Sampaio MS, Jiang Y, Reddy R, et al. Risk factors for development of new-onset diabetes mellitus in adult heart transplant recipients. Transplantation. 2010; 89:1526–1532. [PubMed: 20431437] 56. Kahn J, Rehak P, Schweiger M, Wasler A, Wascher T, et al. The impact of overweight on the development of diabetes after heart transplantation. Clin Transplant. 2006; 20:62–66. [PubMed: 16556155]
Author Manuscript Heart Lung. Author manuscript; available in PMC 2017 July 01.
Jalowiec et al.
Page 13
Author Manuscript Author Manuscript
Fig. 1.
Flow chart showing how the analysis sample size evolved from 347 patients who received a heart transplant (HT) to the sample size at 3 years after HT surgery.
Author Manuscript Author Manuscript Heart Lung. Author manuscript; available in PMC 2017 July 01.
Jalowiec et al.
Page 14
Author Manuscript Author Manuscript
Fig. 2.
Kaplan–Meier survival curves for the first 3 years after heart transplant surgery in 2 posttransplant weight groups: Group 1 = 108 non-overweight patients (body mass index 20%g
CMV mismatchh 11.7%
31.8%
26 ± 9
183 ± 59
185 ± 50
1.4 ± .4
2.3 ± 1.3
8.8%
54.0%
3.3%
6.3%
7.9%
4.6%
58.6%
48.5%
70.7%
21.3%
27± 3
13.8%
15.9%
52 ± 9
Group 2 (N = 239)
.65
1.22
2.08
.19
2.45
.33
1.64
.91
.15
9.50
.05
5.92
4.28
.49
8.71
χ2b
.51
1.75
2.40
.54
17.78
.06
tc
.486
.312
.614
.081
.017
.589
.039
.835
.129
.552
.270
.416
.784
.002
.908
.011
.025
.000
.514
.004
.951
Pd
T-tests (t) were used for continuous variables (mean ± standard deviation).
c
Chi square tests (χ2) were used for categorical variables (%).
b
a Weight groups based on mean post-HT BMI: Group 1 (non-overweight) = BMI 10%
3.7%
Repeat HT
4.6%
40.7%
CAD as reason for HTf
63.0%
47.2%
Urgent priority for HT
IV inotropes at HT
57.4%
Ventilator at HT
12.0%
Smoking history
21 ±3
Diabetes
at HT
16.7%
Minority racee
BMI
29.6%
(kg/m2)
52 ± 12
Female gender
Group 1 (N = 108)
Age at HT (years)
Characteristic
Baseline characteristics of 347 HT patients by 2 post-HT weight groupsa: Group 1 = non-overweight; Group 2 = overweight.
Author Manuscript
Table 1 Jalowiec et al. Page 15
Author Manuscript CMV mismatch: donor positive/patient negative.
Weight mismatch >20%: percent difference between patient weight and donor weight in kilograms.
h
g
Other reasons for HT included: dilated cardiomyopathy, valvular heart disease, congenital heart disease, myocarditis, and previous graft failure.
f
Minorities included: African-Americans, Hispanics, and Asians.
Significance determined at P ≤ .025.
Author Manuscript
e
Author Manuscript
d
Jalowiec et al. Page 16
Author Manuscript
Heart Lung. Author manuscript; available in PMC 2017 July 01.
Jalowiec et al.
Page 17
Table 2
Author Manuscript
Cause of death for 72 of 347 patients (20.7%) who died during the first 3 years after HT surgery by 2 post-HT weight groupsa: Group 1 = non-overweight; Group 2 = overweight. Cause of deathb
Author Manuscript
Group 1 (N = 108)
Group 2 (N = 239)
CMV infection
4
3
7
Bacterial infection
4
3
7
Fungal infection
3
5
8
Protozoal infection
0
1
1
Acute rejection
5
8
13
Late graft failure
0
1
1
CAV
3
1
4
Right ventricular failure
0
3
3
Respiratory failure
1
1
2
Multi-organ failure
0
3
3
Lymphoma
2
1
3
Cerebral hemorrhage
1
1
2
Stroke
3
2
5
Dissecting aortic aneurysm
1
0
1
Myocardial infarction
2
2
4
Pulmonary embolism
0
2
2
Pancreatitis
1
1
2
Intra-operative pump failure
1
2
3
Intra-operative hemorrhage
0
1
1
31
41
72
28.7%
17.2%
Number of deaths Percent of each group who died
Total
Author Manuscript
CAV, cardiac allograft vasculopathy; CMV, cytomegalovirus; HT, heart transplant.
a
Weight groups based on mean post-transplant BMI (body mass index = kg/m2): Group 1 (non-overweight) = BMI 2.5 mg/dl or a diagnosis of renal failure or on dialysis.9
e
d
c MANCOVA (F) was used for continuous outcomes (mean ± standard deviation) and adjusted for covariates of patient gender, patient age at HT, and donor age.
Logistic regression (χ2) was used for dichotomous outcomes (%) and adjusted for covariates of patient gender, patient age at HT, and donor age.
b
Weight groups based on mean post-transplant BMI (body mass index = kg/m2): Group 1 (non-overweight) = BMI
Heart Lung. Author manuscript; available in PMC 2017 July 01. Published in final edited form as: Heart Lung. 2016 ; 45(4): 298–304. doi:10.1016/j.hrtlng.2016.03.005.
Clinical outcomes in overweight heart transplant recipients Anne Jalowiec, PhD, RNa,*, Kathleen L. Grady, PhD, RNb,c, and Connie White–Williams, PhD, RNd,e aSchool
of Nursing, Loyola University of Chicago, Chicago, IL, USA
bCenter
for Heart Failure, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
Author Manuscript
cFeinberg dCenter
School of Medicine, Northwestern University, Chicago, IL, USA
for Nursing Excellence, University of Alabama at Birmingham Hospital, Birmingham, AL,
USA eUniversity
of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
Abstract Background—There is a paucity of research examining the impact of patient weight after heart transplant (HT) on multiple clinical outcomes.
Author Manuscript
Objectives—The purpose of this study was to compare 9 clinical outcomes in 2 groups of HT recipients (N = 347) from 2 hospitals in the midwestern and southern United States, based on their mean body mass index (BMI) during the first 3 years post-HT, and to identify risk factors for mortality. Methods—The sample was divided into 2 groups: Group 1: 108 non-overweight patients (BMI 20 years) following heart transplantation. J Cardiovasc Surg (Torino). 2012; 53:677–684. 51. Delgado JF, Crespo-Leiro MG, Gomez-Sanchez MA, Paniagua MJ, Gonzalez-Vilchez F, et al. Risk factors associated with moderate-to-severe renal dysfunction among heart transplant patients: results from the CAPRI study. Clin Transplant. 2010; 24:E194–E200. [PubMed: 20597926] 52. Hamour IM, Omar F, Lyster HS, Palmer A, Banner NR. Chronic kidney disease after heart transplantation. Nephrol Dial Transplant. 2009; 24:1655–1662. [PubMed: 19168463] 53. Bedanova H, Ondrasek J, Cerny J, Orban M, Spinarova L, et al. Impact of diabetes mellitus on survival rates after heart transplantation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009; 153:283–287. [PubMed: 20208968] 54. Nieuwenhuis MG, Kirkels JH. Predictability and other aspects of post-transplant diabetes mellitus in heart transplant recipients. J Heart Lung Transplant. 2001; 20:703–708. [PubMed: 11448794] 55. Ye X, Kuo HT, Sampaio MS, Jiang Y, Reddy R, et al. Risk factors for development of new-onset diabetes mellitus in adult heart transplant recipients. Transplantation. 2010; 89:1526–1532. [PubMed: 20431437] 56. Kahn J, Rehak P, Schweiger M, Wasler A, Wascher T, et al. The impact of overweight on the development of diabetes after heart transplantation. Clin Transplant. 2006; 20:62–66. [PubMed: 16556155]
Author Manuscript Heart Lung. Author manuscript; available in PMC 2017 July 01.
Jalowiec et al.
Page 13
Author Manuscript Author Manuscript
Fig. 1.
Flow chart showing how the analysis sample size evolved from 347 patients who received a heart transplant (HT) to the sample size at 3 years after HT surgery.
Author Manuscript Author Manuscript Heart Lung. Author manuscript; available in PMC 2017 July 01.
Jalowiec et al.
Page 14
Author Manuscript Author Manuscript
Fig. 2.
Kaplan–Meier survival curves for the first 3 years after heart transplant surgery in 2 posttransplant weight groups: Group 1 = 108 non-overweight patients (body mass index 20%g
CMV mismatchh 11.7%
31.8%
26 ± 9
183 ± 59
185 ± 50
1.4 ± .4
2.3 ± 1.3
8.8%
54.0%
3.3%
6.3%
7.9%
4.6%
58.6%
48.5%
70.7%
21.3%
27± 3
13.8%
15.9%
52 ± 9
Group 2 (N = 239)
.65
1.22
2.08
.19
2.45
.33
1.64
.91
.15
9.50
.05
5.92
4.28
.49
8.71
χ2b
.51
1.75
2.40
.54
17.78
.06
tc
.486
.312
.614
.081
.017
.589
.039
.835
.129
.552
.270
.416
.784
.002
.908
.011
.025
.000
.514
.004
.951
Pd
T-tests (t) were used for continuous variables (mean ± standard deviation).
c
Chi square tests (χ2) were used for categorical variables (%).
b
a Weight groups based on mean post-HT BMI: Group 1 (non-overweight) = BMI 10%
3.7%
Repeat HT
4.6%
40.7%
CAD as reason for HTf
63.0%
47.2%
Urgent priority for HT
IV inotropes at HT
57.4%
Ventilator at HT
12.0%
Smoking history
21 ±3
Diabetes
at HT
16.7%
Minority racee
BMI
29.6%
(kg/m2)
52 ± 12
Female gender
Group 1 (N = 108)
Age at HT (years)
Characteristic
Baseline characteristics of 347 HT patients by 2 post-HT weight groupsa: Group 1 = non-overweight; Group 2 = overweight.
Author Manuscript
Table 1 Jalowiec et al. Page 15
Author Manuscript CMV mismatch: donor positive/patient negative.
Weight mismatch >20%: percent difference between patient weight and donor weight in kilograms.
h
g
Other reasons for HT included: dilated cardiomyopathy, valvular heart disease, congenital heart disease, myocarditis, and previous graft failure.
f
Minorities included: African-Americans, Hispanics, and Asians.
Significance determined at P ≤ .025.
Author Manuscript
e
Author Manuscript
d
Jalowiec et al. Page 16
Author Manuscript
Heart Lung. Author manuscript; available in PMC 2017 July 01.
Jalowiec et al.
Page 17
Table 2
Author Manuscript
Cause of death for 72 of 347 patients (20.7%) who died during the first 3 years after HT surgery by 2 post-HT weight groupsa: Group 1 = non-overweight; Group 2 = overweight. Cause of deathb
Author Manuscript
Group 1 (N = 108)
Group 2 (N = 239)
CMV infection
4
3
7
Bacterial infection
4
3
7
Fungal infection
3
5
8
Protozoal infection
0
1
1
Acute rejection
5
8
13
Late graft failure
0
1
1
CAV
3
1
4
Right ventricular failure
0
3
3
Respiratory failure
1
1
2
Multi-organ failure
0
3
3
Lymphoma
2
1
3
Cerebral hemorrhage
1
1
2
Stroke
3
2
5
Dissecting aortic aneurysm
1
0
1
Myocardial infarction
2
2
4
Pulmonary embolism
0
2
2
Pancreatitis
1
1
2
Intra-operative pump failure
1
2
3
Intra-operative hemorrhage
0
1
1
31
41
72
28.7%
17.2%
Number of deaths Percent of each group who died
Total
Author Manuscript
CAV, cardiac allograft vasculopathy; CMV, cytomegalovirus; HT, heart transplant.
a
Weight groups based on mean post-transplant BMI (body mass index = kg/m2): Group 1 (non-overweight) = BMI 2.5 mg/dl or a diagnosis of renal failure or on dialysis.9
e
d
c MANCOVA (F) was used for continuous outcomes (mean ± standard deviation) and adjusted for covariates of patient gender, patient age at HT, and donor age.
Logistic regression (χ2) was used for dichotomous outcomes (%) and adjusted for covariates of patient gender, patient age at HT, and donor age.
b
Weight groups based on mean post-transplant BMI (body mass index = kg/m2): Group 1 (non-overweight) = BMI
