Low body mass index is associated with increased waitlist mortality among children listed for heart transplant

Davies, Ryan R.; Haldeman, S.; McCulloch, Michael A.; Gidding, Samuel S.; Pizarro, Christian

doi:10.1016/j.healun.2015.05.023

Cited by 22 publications

(27 citation statements)

References 49 publications

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“…Comparisons of these and other studies to each other and to the present study are difficult; however, because of the wide variation in their definitions of malnutrition and the outcomes they measured . One advantage of our study is the use of standardized ASPEN definitions of malnutrition severity, which are derived from expert consensus, conform to World Health Organization (WHO) standard growth curves, and have been used in several patient populations, including critically ill children .…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of malnutrition in this population is multifactorial, due to a combination of decreased intake caused by fatigue and anorexia coupled with increased nutrient requirements resulting from gastrointestinal losses, inflammation, hypermetabolism, and malabsorption . Malnutrition remains a serious problem in both adult and pediatric HF, and is a risk factor for both poor waitlist outcomes as well as reduced posttransplant survival …”

Section: Introductionmentioning

confidence: 99%

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Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Hollander

Schultz

Dennis

et al. 2019

Pediatric Transplantation

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Background Malnutrition is common in pediatric heart failure and is associated with mortality. The effect of VAD support on malnutrition in children is unknown. We sought to compare the prevalence and severity of malnutrition at HT in children on VAD support vs OMT to inform decisions regarding support strategies. Methods Retrospective chart review involving all patients <18 years who underwent HT at Stanford between 1/1/2011 and 3/1/2018. Malnutrition diagnosis and severity were defined by ASPEN guidelines using the lowest age‐adjusted z‐score for weight (WAZ), height (HAZ), and BMI (BMIZ) when the patient was euvolemic. Changes in z‐scores from baseline to HT and across groups were analyzed. Results A total of 104 patients (52 in each group) were included. Among all patients, WAZ (−0.9 vs 0.3, P < 0.001) and BMIZ (0 vs 0.6, P < 0.001) improved while HAZ (−0.9 vs −0.9, P = 0.4) did not. Compared to children on OMT, children on VAD experienced greater increases in WAZ (0.8 vs 0.3, P < 0.001) and BMIZ (0.7 vs 0.2, P < 0.003) at HT. The prevalence of moderate‐to‐severe malnutrition decreased in VAD patients (40% to 19%, P < 0.001) and increased in OMT patients (37% to 46%, P < 0.001), leading to a lower prevalence of moderate‐to‐severe malnutrition at HT (19% vs 46%, P = 0.003). Conclusions Malnutrition is common in pediatric HT candidates. Compared to children on OMT, children on VAD support had greater improvement in nutritional status while awaiting HT, and a lower prevalence of malnutrition at HT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Hollander

Schultz

Dennis

et al. 2019

Pediatric Transplantation

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“…The data in pediatric populations are less clear, with conflicting outcomes reported by single‐center studies noting both no effect on 1‐year survival for patients ≥95 percentile at time of transplant and increased mortality at 1 and 5 years in those ≥95 percentile at time of listing . Results from the ISHLT registry showed no association on 10‐year survival in patients who were abnormal weight (<5 percentile or >95 percentile) at time of transplant, while data from the UNOS registry suggested a small but significant effect of BMI on post‐transplant survival . Only one of these studies distinguished between overweight (BMI = 86‐95 percentile) and obese (BMI > 95 percentile) patients, while the remainder included overweight individuals in the normal group, potentially minimizing the effect of weight status on transplant outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Results from the ISHLT registry showed no association on 10‐year survival in patients who were abnormal weight (<5 percentile or >95 percentile) at time of transplant, while data from the UNOS registry suggested a small but significant effect of BMI on post‐transplant survival . Only one of these studies distinguished between overweight (BMI = 86‐95 percentile) and obese (BMI > 95 percentile) patients, while the remainder included overweight individuals in the normal group, potentially minimizing the effect of weight status on transplant outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Adult‐based guidelines for heart transplantation use obesity as a relative contraindication and recommend mandatory weight loss prior to listing for all patients with BMI > 35 (class 2 obesity) . Unfortunately, no clear guidelines exist for pediatric patients, with available data regarding the effect of obesity on post‐transplant outcomes mixed, showing both no effect and increased mortality when compared to the non‐obese . Moreover, overweight status (BMI = 86%‐95 percentile) is generally included in the normal weight group which may complicate results.…”

Section: Introductionmentioning

confidence: 99%

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Obesity class does not further stratify outcome in overweight and obese pediatric patients after heart transplantation

Ryan

Zafar

Siegel

et al. 2018

Pediatric Transplantation

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The effect of obesity stratification on pediatric heart transplant outcomes is unknown. The UNOS database was queried for patients ≥2-<18 years listed for heart transplant and stratified by BMI: normal (BMI>5%-≤85 percentile), overweight (BMI=86%-95 percentile), class 1 (BMI=100%-120% of 95 percentile), class 2 (BMI=121%-140% of 95 percentile), and class 3 obesity (BMI>140% of 95 percentile). A total of 5056 individuals were listed for transplant, with 71% normal, 13% overweight, 10% class 1, 4% class 2, and 2% class 3 obesity. Waitlist survival was not different between groups. Post-transplant survival was decreased in overweight and combined obese groups vs normal, with no further difference between overweight and obese classes. Overweight and obese patients had higher listing status and were more likely to have ventilator, inotrope, and mechanical circulatory support at listing. After transplant, there was an association of overweight-obese patients with diabetes and rejection requiring hospitalization. Stricter definition of normal weight reveals overweight-obese status was an independent risk factor for poorer post-transplant survival, without further effect by stratification of weight class. However, because there is no difference in waitlist survival, this study does not allow the selection of absolute weight-based criteria regarding transplant listing and suggests the need to look further for modifiable risk factors post-transplant.

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Pediatric Heart Transplantation

Power,

Dipchand

2023

Pediatric Cardiology

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Low body mass index is associated with increased waitlist mortality among children listed for heart transplant

Cited by 22 publications

References 49 publications

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Obesity class does not further stratify outcome in overweight and obese pediatric patients after heart transplantation

Pediatric Heart Transplantation

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