The Impact of Obesity and LVAD-Bridging on Heart Transplant Candidate Outcomes: A Linked STS INTERMACS - UNOS Data Analysis

Purpose Limited data integrating waitlist and post-heart transplant (HT) mortality have evaluated outcomes of LVAD-bridged strategy vs no LVAD based on patient characteristics. We aimed to evaluate waitlist and post-HT mortality in bridged in comparison to non-bridged patients based on body mass index (BMI). Methods We included adults listed for HT in UNOS and patients receiving durable LVAD as bridge to HT or candidacy in STS/INTERMACS databases (2010-2019). Using patient identifiers, we linked both databases. We categorized patients as underweight (BMI Endpoints We included 12,761 LVAD-bridged and 17,518 non-bridged candidates. Bridged vs non-bridged patients were more frequently obese (37.2 vs 28.7%) or underweight (3.6 vs 2.6%) (p LVAD-bridged patients had higher waitlist mortality and lower HT probability in comparison to non-bridged in overweight and obese patients. We will next integrate these results with post-HT survival in the linked STS-INTERMACS/UNOS cohort to provide further insights into the strategy most likely to lead to survival benefit based on BMI and determine whether the current guideline recommendation of using LVAD as a bridge to weight loss should be re-examined.