Relation of Malnutrition to Outcome Following Orthotopic Heart Transplantation

There are approximately 2,200 orthotopic heart transplant (OHT) surgeries performed annually in the United States.1 Most of the recipients are chronically ill with long-standing heart failure, and a prevalence of malnutrition ranging from 35% to 57%.2 The decision surrounding candidacy is based on a careful assessment of risk (including malnutrition) and benefits, and in many cases, OHT may proceed despite underlying malnutrition. After adjusting for all baseline co-morbidities, malnutrition was an independent predictor of all-cause in-hospital mortality (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.08 to 2.80, p < 0.001). Malnourishment in advanced heart failure is frequent and may be multifactorial, secondary to an increased systemic inflammatory response, congestive gastropathy leading to a protein-losing enteropathy, and heightened levels of circulating catecholamines.