TY - JOUR
T1 - Low body mass index is associated with increased waitlist mortality among children listed for heart transplant
AU - Davies, Ryan R
AU - Haldeman, Shylah
AU - McCulloch, Michael A.
AU - Gidding, Samuel S.
AU - Pizarro, Christian
N1 - Funding Information:
This work was supported in part by Health Resources and Services Administration Contract 231-00-0115. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services; mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. government. This analysis is based on data from the Organ Procurement and Transplantation Network as of September 2012.
Publisher Copyright:
© 2015 International Society for Heart and Lung Transplantation.
PY - 2015/11
Y1 - 2015/11
N2 - 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.
AB - 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.
KW - cardiac transplantation
KW - obesity
KW - outcomes
KW - pediatrics
KW - survival analysis
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U2 - 10.1016/j.healun.2015.05.023
DO - 10.1016/j.healun.2015.05.023
M3 - Article
C2 - 26212660
AN - SCOPUS:84946481946
SN - 1053-2498
VL - 34
SP - 1462
EP - 1470
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 11
ER -