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

作者：Davies Ryan R^*; Haldeman Shylah; McCulloch Michael A; Gidding Samuel S; Pizarro Christian

来源：Journal of Heart and Lung Transplantation, 2015, 34(11): 1462-1470.

DOI：10.1016/j.healun.2015.05.023

• cardiac transplantation
• pediatrics
• obesity
• survival analysis
• outcomes

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.

• 出版日期2015-11