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Abnormal nutrition affects waitlist mortality in infants awaiting heart transplant
Justin Godown1, Joshua M Friedland-Little1, Robert J Gajarski1
1Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
Insights
In young children awaiting heart transplant (HTx), moderate to severe wasting and elevated weight-to-height ratios increase waitlist mortality risk. However, pre-HTx nutritional status does not impact survival after the procedure.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Nutritional Science
Background:
- Nutritional status is known to impact survival in adult and older pediatric heart transplant (HTx) recipients.
- The effect of nutritional status on outcomes in very young children (0-2 years) undergoing HTx remains largely unknown.
Purpose of the Study:
- To investigate the association between pre-transplant nutritional status and outcomes in children aged 0 to 2 years undergoing heart transplant.
- To identify specific nutritional parameters that may influence waitlist mortality and post-transplant survival in this pediatric population.
Main Methods:
- Retrospective analysis of 1,653 children (0-2 years) listed for HTx between 1997 and 2011 using the Organ Procurement and Transplantation Network database.
- Nutritional status categorized by percentage of ideal body weight and weight-to-height ratio at listing and transplant.
- Logistic regression and Cox proportional hazard models used to assess risk factors for waitlist mortality and post-HTx survival.
Main Results:
- Moderate/severe wasting and elevated weight-to-height ratios were identified as independent risk factors for waitlist mortality (aOR 1.9 and 1.7, respectively).
- Of 1,167 transplanted patients, 87% survived to 1-year post-HTx.
- Pre-transplant nutritional status did not significantly affect post-HTx mortality, need for reoperation, dialysis, infection, stroke, or rejection before discharge.
Conclusions:
- Moderate to severe wasting and elevated weight-to-height ratios are significant predictors of waitlist mortality in pediatric patients under 2 years awaiting heart transplant.
- Optimizing nutritional status before heart transplant can be a viable strategy to mitigate waitlist mortality in this vulnerable age group.
- Nutritional status prior to heart transplant does not appear to influence long-term survival or early post-operative complications in young children.
Background:
Although nutritional status affects survival after heart transplant (HTx) in adults and older children, its effect on outcomes in young children is unknown. This study aimed to assess the effect of pre-HTx nutrition on outcomes in this population.
Methods:
Children aged 0 to 2 years old listed for HTx from 1997 to 2011 were identified from the Organ Procurement and Transplantation Network database. Nutritional status was classified according to percentage of ideal body weight at listing and at HTx. Logistic regression analysis evaluated the risk of waitlist mortality. Cox proportional hazard models assessed the effect of nutrition on post-HTx survival.
Results:
Of 1,653 children evaluated, 899 (54%) had normal nutrition at listing, 445 (27%) were mildly wasted, 203 (12%) were moderate or severely wasted, and 106 (6%) had an elevated weight-to-height (W:H) ratio. Moderate or severe wasting (adjusted odds ratio, 1.9; 95% confidence interval, 1.3-2.7) and elevated W:H (adjusted odds ratio, 1.7; 95% confidence interval, 1.1-2.6) were independent risk factors for waitlist mortality. HTx was performed in 1,167 patients, and 1,016 (87%) survived to 1-year post-HTx. Nutritional status at listing or at HTx was not associated with increased post-HTx mortality. Nutritional status did not affect the need for early reoperation, dialysis, or the incidences of infection, stroke, or rejection before hospital discharge.
Conclusions:
Moderate or severe wasting and an elevated W:H are independent risk factors for waitlist mortality in patients aged < 2 years but do not affect post-HTx mortality. Optimization of pre-HTx nutritional status constitutes a strategy to reduce waitlist mortality in this age range.
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