{
  "abstract": "Background: Body mass index has paradoxical associations with outcomes in advanced heart failure, but whether its relationship with survival after heart transplantation differs by sex remains uncertain.\n\nMethods: We analyzed 1059 adult heart transplant recipients enrolled in the Korean Organ Transplantation Registry from 2014 through 2023. Body mass index was assessed using Asian-specific BMI categories and 3-knot restricted cubic splines. The primary outcome was all-cause mortality. Multivariable Cox models adjusted for prespecified clinical characteristics and pretransplant support. Sex differences in the body mass index–mortality association were evaluated using restricted cubic spline modeling.\n\nResults: The cohort included 304 female patients, and 217 deaths occurred during a median follow-up of 3.6 years. The body mass index–mortality association differed by sex in the pooled spline model (P for interaction=0.041). In male patients, the association was nonlinear and U-shaped (P for overall association=0.031; P for nonlinearity=0.017). Underweight was associated with higher mortality than normal weight (adjusted hazard ratio, 1.97; 95% confidence interval, 1.17–3.33). In female patients, the fitted association was inverse, without evidence of nonlinearity (P for overall association=0.030; P for nonlinearity=0.302). Obesity class I was associated with lower mortality than normal weight (adjusted hazard ratio, 0.24; 95% confidence interval, 0.08–0.73), although this estimate was based on few events.\n\nConclusions: The association between body mass index and mortality after heart transplantation may differ by sex. The apparent lower mortality among female patients with obesity class I is hypothesis-generating and requires external validation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea",
    "Division of Cardiology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea",
    "Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea",
    "Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea",
    "Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea",
    "Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yoseb Lee"
    },
    {
      "affs": [
        0
      ],
      "name": "Kitae Kim"
    },
    {
      "affs": [
        1
      ],
      "name": "Ah Ram Kim"
    },
    {
      "affs": [
        0
      ],
      "name": "Jung Ae Hong"
    },
    {
      "affs": [
        1
      ],
      "name": "Junho Hyun"
    },
    {
      "affs": [
        1
      ],
      "name": "Sang Eun Lee"
    },
    {
      "affs": [
        1
      ],
      "name": "Min-Seok Kim"
    },
    {
      "affs": [
        2
      ],
      "name": "Eun-Seok Jeon"
    },
    {
      "affs": [
        2
      ],
      "name": "Jin-Oh Choi"
    },
    {
      "affs": [
        3
      ],
      "name": "Jaewon Oh"
    },
    {
      "affs": [
        3
      ],
      "name": "Seok-Min Kang"
    },
    {
      "affs": [
        4
      ],
      "name": "Myoung Soo Kim"
    },
    {
      "affs": [
        1
      ],
      "name": "Jae-Joong Kim"
    },
    {
      "affs": [
        5
      ],
      "name": "Hae-Young Lee"
    },
    {
      "affs": [
        0
      ],
      "name": "Sung-Ho Jung"
    },
    {
      "name": "The KOTRY Study Group"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/48qt30f96xwdy.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jhlto.2026.100703",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13737392/",
  "id": "48qt30f96xwdy",
  "issns": [
    "2950-1334"
  ],
  "landing_url": "https://doi.org/10.1016/j.jhlto.2026.100703",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2746|Transplantation: Methods and Outcomes"
    ]
  ],
  "openalex": "W7220360201",
  "pdf_url": "https://www.jhltopen.org/article/S2950-1334(26)00224-7/pdf",
  "pmcid": "PMC13737392",
  "pmid": "42991454",
  "published": "2026-10-05",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/48qt30f96xwdy.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:22:35Z",
      "native_id": "PMC13737392",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jhlto.2026.100703"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Transplantation: Methods and Outcomes",
      "subfield": "surgery"
    }
  ],
  "title": "Sex-specific association between body mass index and mortality after heart transplantation: A nationwide KOTRY Cohort Study1",
  "title_text": "Sex-specific association between body mass index and mortality after heart transplantation: A nationwide KOTRY Cohort Study1",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:22:35Z",
  "url": "https://research.draconitic.com/paper/48qt30f96xwdy",
  "venue": "JHLT Open",
  "versions": []
}