Reversibility of cardiac cachexia after heart transplantation

Background: Cachexia is an independent risk factor for mortality in patients with chronic heart failure and increases mortality even after heart transplantation (HTx). We aimed to determine whether cardiac cachexia is reversible after HTx, and investigated differences specific to gender. Methods: We prospectively examined 106 patients before and serially 3, 6, 12 and 24 months after HTx (18 women, 88 men; median age at transplantation 53.7 +/- 9.7 years; n = 68 dilative cardiomyopathy, n 33 coronary heart disease, n = 5 other origin of heart failure). Patients were sub-grouped as underweight (body mass index [BMI] <= 21 kg/m(2), n = 15), normal weight (BMI 21 to 27 kg/m(2), n = 64) and obese (BMI >= 27 kg/m(2), n = 27). Results: Body weight increase was restricted to underweight patients: at 3 months (+6.8% vs pre-transplant weight); at 6 months (+11.3%), at 12 months (+15.6%); and at 24 months (+17.7%, all p <= 0.03). The entire population had weight loss at 3 months (-2.9%), but had weight gain at 6 (+2.5%), 12 (+6.1%, all p <= 0.02) and 24 months (+1.3%, P = 0.44). A lower BMI before HTx correlated significantly with greater weight increase after HTx at every follow-up time-point (r = 0155; p < 0.001). There were no gender-specific differences for BMI or weight change. Weight loss within 3 months after HTx was associated with higher mortality during 4 years of follow-up. Conclusions: Weight gain after HTx is particularly strong in underweight patients, and the increased cardiac function causes the cessation of cachexia. The weight increase of the entire heart transplant population is partially an effect of reversibility of cachexia and not affected by gender.