S. Bakhtiyar1,2, S. Sakowitz1, S. Mallick1, K. Ali1, J. Curry1, S. Kim1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles, Surgery, Los Angeles, CA, USA 2University Of Colorado Denver, Surgery, Aurora, CO, USA
Introduction:
Temporary inactivation on the heart transplantation (HT) waiting list has been associated with inferior post-transplantation survival. One such reason for inactivation is for a “weight currently inappropriate for transplant.” While higher body mass index (BMI) is linked with inferior post-transplantation survival, little is known about these patients temporarily-inactivated due to weight. The present study sought to characterize this cohort and analyze their waitlist outcomes.
Methods:
This retrospective cohort study of the Organ Procurement and Transplantation Network database considered all adults ≥18 years listed for first-time, isolated HT from 2000-2023 who experienced temporary inactivation (status 7). Patients with a BMI≥30 and who were temporarily inactive due to reason 9 (weight currently inappropriate for transplant) were classified as the Obese Inactive (OI) cohort.
Competing risk regressions using the method of Fine and Gray were conducted to consider the impact of inactivation due to weight on waitlist mortality or clinical deterioration, transplantation, or recovery, as well as conversion to active status.
Results:
Of 21,889 patients temporarily inactivated on the waitlist, 639 (0.1%) comprised the OI group. On average, OI was younger (48[39-56] vs 55years[45-62], P<0.001), of a higher BMI(35.5±3.4 vs 27.6±5.0, P<0.001), more commonly of Black race (40 vs 21%, P<0.001) and diabetic (39 vs 29%, P<0.001), compared to other inactivated patients. OI remained inactive for a longer duration relative to others (902 [460-1477] vs 267 days [78-745], P<0.001).
Notably, OI patients less frequently received a transplant compared to all others inactivated (21 vs 68%, P<0.001). Among the OI cohort, Black patients less often underwent transplantation (17 vs 24%, P<0.001).
Relative to all temporarily inactivated patients, OI demonstrated similar hazard of remaining inactive on the waitlist (Subdistribution Hazard Ratio[SHR] 1.06, 95%Confidence Interval[CI] 0.94-1.20). Yet, Black OI patients demonstrated significantly greater hazard of remaining inactive on the waitlist (SHR 1.68, CI 1.28-2.21), compared to other OI.
Additionally, OI demonstrated significantly greater hazard of mortality on the waitlist (SHR 1.79, CI 1.60-2.01).
Conclusion:
Obese patients inactivated due to their weight experienced significantly longer duration in inactivated status. Further, Black OI patients were less likely to convert to active status. In addition, OI candidates faced greater hazard of mortality on the waitlist, relative to other inactivated patients. Considering the growing obesity epidemic, novel interventions are needed to more equitably manage these patients and improve waitlist outcomes.
