Ryan R Davies1, Shylah Haldeman2, Michael A McCulloch3, Samuel S Gidding3, Christian Pizarro3. 1. Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: rdavies@nemours.org. 2. Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware. 3. Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: In adults, low body mass index (BMI) and high BMI have been associated with increased mortality after heart transplantation. Studies of BMI in children with heart failure have had inconsistent results. METHODS: The United Network for Organ Sharing database has 4,035 listings for primary, isolated heart transplant in patients 3 to 18 years old (1995-2012). BMI percentile-for-age (BMI%) was calculated, and patients were stratified based on BMI% into 4 groups: underweight (BMI% <5, n = 701 [17.4%]), normal weight (BMI% 5-84, n = 2,321 [57.5%]), overweight (BMI% 85-94, n = 440 [10.9%]), or obese (BMI% ≥95, n = 573 [14.2%]). Outcomes of patients on the waitlist and after transplantation were assessed. RESULTS: Unadjusted early waitlist mortality was highest in underweight patients (16.7%) compared with normal-weight (11.4%), overweight (10.9%), and obese (12.9%) patients (p = 0.04). In multivariable analysis, underweight patients had elevated risk-adjusted waitlist mortality (odds ratio = 1.4, 95% confidence interval = 1.0-2.2). Unadjusted post-transplant mortality did not differ across BMI% groups (underweight, 5.7%; normal weight, 5.4%; overweight, 5.5%; obese, 5.8%), but obese patients had borderline higher risk-adjusted post-transplant mortality (odds ratio = 1.7, 95% confidence interval = 1.0-3.0). Change in BMI% while waiting did not affect post-transplant mortality. CONCLUSIONS: Children listed for heart transplant are commonly either underweight or obese. Underweight patients have high risk-adjusted mortality before transplantation, whereas obese patients have borderline higher adjusted post-transplant mortality.
BACKGROUND: In adults, low body mass index (BMI) and high BMI have been associated with increased mortality after heart transplantation. Studies of BMI in children with heart failure have had inconsistent results. METHODS: The United Network for Organ Sharing database has 4,035 listings for primary, isolated heart transplant in patients 3 to 18 years old (1995-2012). BMI percentile-for-age (BMI%) was calculated, and patients were stratified based on BMI% into 4 groups: underweight (BMI% <5, n = 701 [17.4%]), normal weight (BMI% 5-84, n = 2,321 [57.5%]), overweight (BMI% 85-94, n = 440 [10.9%]), or obese (BMI% ≥95, n = 573 [14.2%]). Outcomes of patients on the waitlist and after transplantation were assessed. RESULTS: Unadjusted early waitlist mortality was highest in underweight patients (16.7%) compared with normal-weight (11.4%), overweight (10.9%), and obese (12.9%) patients (p = 0.04). In multivariable analysis, underweight patients had elevated risk-adjusted waitlist mortality (odds ratio = 1.4, 95% confidence interval = 1.0-2.2). Unadjusted post-transplant mortality did not differ across BMI% groups (underweight, 5.7%; normal weight, 5.4%; overweight, 5.5%; obese, 5.8%), but obesepatients had borderline higher risk-adjusted post-transplant mortality (odds ratio = 1.7, 95% confidence interval = 1.0-3.0). Change in BMI% while waiting did not affect post-transplant mortality. CONCLUSIONS:Children listed for heart transplant are commonly either underweight or obese. Underweight patients have high risk-adjusted mortality before transplantation, whereas obesepatients have borderline higher adjusted post-transplant mortality.
Authors: Chesney D Castleberry; John L Jefferies; Ling Shi; James D Wilkinson; Jeffrey A Towbin; Ryan W Harrison; Joseph W Rossano; Elfriede Pahl; Teresa M Lee; Linda J Addonizio; Melanie D Everitt; Justin Godown; Joseph Mahgerefteh; Paolo Rusconi; Charles E Canter; Steven D Colan; Paul F Kantor; Hiedy Razoky; Steven E Lipshultz; Tracie L Miller Journal: JACC Heart Fail Date: 2018-02-07 Impact factor: 12.035
Authors: Angela C Chen; Faustine D Ramirez; David N Rosenthal; Sarah C Couch; Samuel Berry; Katie J Stauffer; Jerrid Brabender; Nancy McDonald; Donna Lee; Lynsey Barkoff; Susan E Nourse; Jeffrey Kazmucha; C Jason Wang; Inger Olson; Elif Seda Selamet Tierney Journal: J Am Heart Assoc Date: 2020-01-24 Impact factor: 5.501