{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:59:20Z","timestamp":1792738760819,"version":"4.5.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,12,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Patients with obesity and advanced heart failure face unique challenges on the path to heart transplantation. There are limited data on waitlist and transplantation outcomes in this population. We aimed to evaluate the impact of obesity on heart transplantation outcomes, and to investigate the effects of the new organ procurement and transplantation network allocation system in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      This cohort study of adult patients listed for heart transplant used the United Network for Organ Sharing database from January 2006 to June 2020. Patients were stratified by body mass index (BMI) (18.5\u201324.9, 25\u201329.9, 30\u201334.9, 35\u201339.9, and 40\u201355 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Recipient characteristics and donor characteristics were analyzed. Outcomes analyzed included transplantation, waitlist death, and posttransplant death. BMI 18.5 to 24.9 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      was used as the reference compared with progressive BMI categories. There were 46\u00a0645 patients listed for transplantation. Patients in higher BMI categories were less likely to be transplanted. The lowest likelihood of transplantation was in the highest BMI category, 40 to 55 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (hazard ratio [HR], 0.19 [0.05\u20130.76];\n                      <jats:italic>P<\/jats:italic>\n                      =0.02). Patients within the 2 highest BMI categories had higher risk of posttransplantation death (HR, 1.29;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001 and HR, 1.65;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001, respectively). Left ventricular assist devices among patients in obese BMI categories decreased after the allocation system change (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001, all). After the change, patients with obesity were more likely to undergo transplantation (BMI 30\u201335 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      : HR, 1.31 [1.18\u20131.46],\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001; BMI 35\u201355 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      : HR, 1.29 [1.06\u20131.58];\n                      <jats:italic>P<\/jats:italic>\n                      =0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">There was an inverse relationship between BMI and likelihood of heart transplantation. Higher BMI was associated with increased risk of posttransplant mortality. Patients with obesity were more likely to undergo transplantation under the revised allocation system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.121.021346","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T07:36:08Z","timestamp":1638430568000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":53,"title":["Impact of Obesity on Heart Transplantation Outcomes"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8715-6718","authenticated-orcid":false,"given":"Fouad","family":"Chouairi","sequence":"first","affiliation":[{"name":"Duke University Department of Internal Medicine Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4183-2586","authenticated-orcid":false,"given":"Aidan","family":"Milner","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sounok","family":"Sen","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0253-1174","authenticated-orcid":false,"given":"Avirup","family":"Guha","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6753-5753","authenticated-orcid":false,"given":"James","family":"Stewart","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1446-0991","authenticated-orcid":false,"given":"Ania M.","family":"Jastreboff","sequence":"additional","affiliation":[{"name":"Section of Endocrinology &amp; Metabolism Department of Internal Medicine Yale School of Medicine New Haven CT"},{"name":"Section of Pediatric Endocrinology Department of Pediatrics Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2367-8354","authenticated-orcid":false,"given":"Makoto","family":"Mori","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Clark","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0595-1492","authenticated-orcid":false,"given":"P. 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