New horizons in transplantationThoracic transplantationImpact of Obesity on Heart and Lung Transplantation: Does Pre-Transplant Obesity Affect Outcomes?

•Rates of obesity have continued to increase over time, leading to an increased number of obese end-stage heart failure and end-stage lung failure recipients being referred for transplantation.•There remains significant controversy regarding the optimal management strategy for obese patients with both end-stage heart and lung failure.•A review of the literature suggests that obesity (BMI 30-34.9) may not be associated with worse outcomes, and perhaps should not be a contraindication to heart transplantation.•There tends to be a greater association between obesity and poorer outcomes in lung transplantation. This may be due in part to an association between BMI and recipient diagnosis, with the higher BMI patients more likely to have a diagnosis associated with worse outcomes.•Further study into the molecular mechanisms that may cause graft dysfunction in obese patients, as well as alter survival rates, is needed to advance our understanding of the relationship between obesity and heart and lung transplantation.

Increasing prevalence of obesity has led to a rise in the number of prospective obese heart and lung transplant recipients. The optimal management strategy of obese patients with end-stage heart and lung failure remains controversial. This review article discusses and provides a summary of the literature surrounding the impact of obesity on outcomes in heart and lung transplantation. Studies on transplant obesity demonstrate controversy in terms of morbidity and mortality outcomes and obesity pre-transplantation. However, the impact of obesity on outcomes seems to be more consistently demonstrated in lung rather than heart transplantation. The ultimate goal in heart and lung transplantation in the obese patient is to identify those at highest risk of complication that may warrant therapies to mitigate risk by addressing comorbid conditions.