Although BMI does not predict mortality post-HT, it can differentiate risk better than all other metrics, with highest and lowest BMI tertiles associated with increased rates of hospital readmission and infection in the first-year post HT.
Key Findings
Results
Both the highest and lowest BMI tertiles were significantly associated with increased risk of hospital readmission within 1 year post heart transplant.
Highest BMI tertile: OR 3.4, 95% CI 1.1–11.4; lowest BMI tertile: OR 5.9, 95% CI 1.7–25.1; p = 0.01
This U-shaped association indicates both extremes of BMI confer elevated readmission risk
Study included 104 patients who underwent heart transplant between 2014 and 2019
Body composition was assessed using CT scans performed within 3 months of transplant analyzed with Slice-O-Matic software
Results
Both the highest and lowest BMI tertiles were significantly associated with increased risk of infections requiring hospitalization within 1 year post heart transplant.
Highest BMI tertile: OR 3.2, 95% CI 1.2–9.0; lowest BMI tertile: OR 3.9, 95% CI 1.4–11.7; p = 0.02
This association was identified through univariate and multivariate logistic regression analyses
The cohort was 80% male and 56% Caucasian
Results
Alternative body composition measures including fat mass index (FMI), visceral-to-subcutaneous adipose tissue ratio (VAT/SAT), fat free mass index (FFMI), and skeletal muscle index (SMI) were not associated with outcomes 1 year post heart transplant.
Outcomes examined included 1-year mortality, readmission, primary graft dysfunction, length of stay, infection, and renal failure
None of FMI, VAT/SAT, FFMI, or SMI showed statistically significant associations with any of these outcomes
These measures were derived from abdominal CT scans using Slice-O-Matic software
Analyses were performed by tertiles using univariate and multivariate logistic regression
Results
BMI was not associated with 1-year mortality post heart transplant.
Despite associations with readmission and infection, BMI did not predict mortality at 1 year
This finding is consistent with the paper's characterization that 'data supporting this recommendation is mixed' regarding the BMI < 35 kg/m² listing guideline
The study examined outcomes in 104 patients over the period 2014–2019
Background
Current heart transplant listing guidelines support a BMI threshold of less than 35 kg/m², but the evidence base for this recommendation is described as mixed.
The guideline specifies BMI < 35 kg/m² for heart transplant listing
The authors note it is unclear whether more specific measurements of body composition are better predictors of post-transplant outcomes
This uncertainty motivated the investigation of alternative body composition metrics derived from CT imaging
Methods
The study cohort consisted of 104 patients who underwent heart transplant between 2014 and 2019 and had abdominal CT scans within 3 months of transplant.
80% of patients were male and 56% were Caucasian
This was a retrospective study design
Body composition variables analyzed included BMI, FMI, VAT/SAT ratio, FFMI, and SMI
Analyses used univariate and multivariate logistic regression with variables grouped by tertiles
Lanier A, Siddiqi U, Siddiqi U, Lee L, Saffari S, Belkin M, et al.. (2026). Alternative Measures of Body Composition and Outcomes Following Heart Transplant.. Clinical transplantation. https://doi.org/10.1111/ctr.70448