Differential effect of body mass index on pediatric heart transplant outcomes based on diagnosis

Area of Science:

• Pediatric Cardiology
• Transplant Surgery
• Nutritional Science

Background:

• The influence of nutritional status on pediatric heart transplant (HTx) waitlist and post-transplant survival remains unclear.
• Existing data on nutrition's role in post-HTx outcomes are conflicting.

Purpose of the Study:

• To investigate the impact of nutritional status, specifically body mass index (BMI) percentile, on waitlist and post-HTx outcomes in pediatric patients.
• To determine if BMI influences mortality risk before and after heart transplantation in children.

Main Methods:

• Retrospective analysis of 2712 children (2-18 years) listed for HTx between 1997 and 2011 from the OPTN database.
• Patients were stratified by BMI percentile.
• Multivariable logistic regression and Cox proportional hazard regression were used to assess the impact of BMI on waitlist and post-HTx mortality, respectively.

Main Results:

• Overall, BMI did not significantly impact waitlist, one-year, or five-year post-HTx mortality.
• However, in patients with congenital malformations (CM), BMI > 95th percentile and BMI < 1st percentile were independent risk factors for waitlist mortality.
• BMI did not affect waitlist mortality in patients with congenital heart disease (CHD) or post-HTx outcomes for either diagnosis.

Conclusions:

• Nutritional status, indicated by extreme BMI percentiles, presents differential risks for waitlist mortality in pediatric heart transplant candidates based on underlying diagnosis.
• Very high or very low BMI is a significant risk factor for waitlist mortality in pediatric patients with congenital malformations (CM), but not congenital heart disease (CHD).
• These findings suggest that an individualized approach to risk assessment and nutritional management, considering the specific disease etiology, is warranted for pediatric HTx candidates.