Prognostic Assessment with the Malnutrition Universal Screening Tool in Heart Transplant Recipients: A Pilot Study and a Single-Center Experience.

Introduction and aims: Malnutrition is associated with increased morbidity and mortality in patients who undergo cardiac surgery. Nevertheless, objective assessment of malnourished patients undergoing heart transplantation (HT) is limited. We aimed to analyze the relationship between the malnutrition status and the early and late clinical outcomes of patients undergoing HT using a novel semi-quantitative tool. Methods: All patients aged ≥18 years who underwent HT between January 2015 and July 2020 in a single center were retrospectively evaluated and included in the study. The semi-quantitative Malnutrition Universal Screening Tool (MUST) score (already validated in heart failure) was calculated for each patient at the time of transplantation to assess their nutritional status. A propensity score weighting approach was performed to evaluate the association between the increase in MUST score and the risk of early complications and in-hospital mortality. A Cox regression analysis was performed to assess follow-up mortality. Results: A total of 168 HT patients (median age 58.4 years, IQR 49.5-65.2, men n = 128, 76%) were included within the study period. Their median preoperative BMI was 24.0 kg/m² (IQR 21.2-27.9). Preoperative MUST scores of 0, 1, and ≥2 were found in 92 (55%), 24 (14%), and 52 (31%) patients, respectively. The median preoperative eGFR was 64.3 mL/min (IQR 49.0-83.2). An increase in MUST score (from 0 to 2) was not significantly related to major postoperative complications or in-hospital mortality. An analogous increase in MUST score was associated with increased follow-up mortality risk (hazard ratio 1.28, 95% CI 1.04-1.83, p = 0.024). Conclusions: Malnutrition assessed with the MUST score seems not to be associated with increased in-hospital mortality or major postoperative complications in patients who undergo HT, but according to our preliminary data it is related to patients' long-term mortality.