First Author: Kiran Merchant, n/a – Research Fellow, Mayo Clinic, Jacksonville Co-Author: Mohamed Antar, n/a – Resident, Ascension St. Joseph Co-Author: Esteban Rodriguez Ferreira, n/a – Resident, Ascension St. Joseph Co-Author: Swapna Sarangi, n/a – Resident, UIC- Peoria Co-Author: Himanshi Banker, n/a – Doctor, Tuscon Medical Center Co-Author: Saptarshi Ghosh, MBBS Co-Author: Anthony Navarrete Rios, n/a – Resident, Ascension St. Joseph Co-Author: Aditya Singh, MD Co-Author: Syed Hamza Shah, n/a – Resident, Ascension St. Joseph Co-Author: Joao Bordini, n/a – Resident, Ascension St. Joseph Co-Author: Uroosa Kumar, n/a – Physician, Aga Khan University
Introduction: Heart transplant recipients admitted to the intensive care unit (ICU) are at high risk of adverse outcomes, and there is growing interest in body composition particularly muscle and fat mass as a modifiable predictor of survival. This systematic review and meta-analysis evaluated the association between body composition parameters and ICU mortality in heart transplant patients.
Methods: We systematically searched PubMed, Embase, and Cochrane CENTRAL up to June 2025 for cohort studies assessing muscle mass, fat mass, and ICU mortality among adult heart transplant recipients. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic. Subgroup and sensitivity analyses were performed to find possible confounders. Artificial Intelligence assist tools were used for improving fluidity, grammar and structure of the writing, has not been included in data curation, analysis and interpretation.
Results: Eleven cohort studies including 1,276 heart transplant patients were identified, with five studies contributing to quantitative meta-analysis. Low muscle mass was significantly associated with increased ICU mortality (HR: 1.31, 95% CI: 1.07–1.96; I² = 47%; 4 studies). This relationship remained stable across sensitivity and subgroup analyses. In contrast, increased fat mass showed no significant association with ICU mortality (pooled adjusted HR: 0.82, 95% CI: 0.34–2.32; I² = 77%). Similarly, higher abdominal fat was not significantly associated with mortality risk.
Conclusions: Among heart transplant recipients in the ICU, low skeletal muscle mass is a significant and independent predictor of mortality, whereas fat mass including abdominal adiposity does not appear to impact survival. These findings underscore the importance of assessing and addressing sarcopenia in perioperative and critical care management. Further prospective studies are needed to define targeted interventions to improve outcomes in this patient population.
