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Growth stunting in single ventricle patients after heart transplantation
Alyssa Power1, Lisa Schultz2, Katelin Dennis2
1Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA, USA.
Insights
Children with single ventricle congenital heart disease show persistent stunting years after heart transplantation. While wasting improves, impaired longitudinal growth suggests ongoing issues beyond the heart condition itself.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Pediatric Nutrition
Background:
- Malnutrition is prevalent in children with single ventricle (SV) congenital heart disease (CHD).
- The long-term nutritional impact of heart transplantation (HT) in SV patients remains understudied.
- Previous research has not fully elucidated anthropometric changes post-HT in this vulnerable population.
Purpose of the Study:
- To evaluate anthropometric changes in single ventricle (SV) patients following heart transplantation (HT).
- To compare nutritional status changes in SV patients versus those transplanted for cardiomyopathy (CM).
- To identify persistent growth impairments after HT in SV patients.
Main Methods:
- Retrospective chart review of pediatric patients (<18 years) undergoing HT.
- Inclusion of patients with SV CHD and cardiomyopathy (CM) from 2010-2017.
- Analysis of anthropometric indices (wasting and stunting) at baseline and 3 years post-HT.
Main Results:
- Stunting was significantly more common in SV patients (61%) compared to CM patients (14%) at transplant (P<.001).
- At 3 years post-HT, SV patients continued to show higher rates of stunting (38%) than CM patients (7%) (P=.01).
- While wasting improved in both groups, stunting persisted in SV patients, indicating ongoing longitudinal growth impairment.
Conclusions:
- Longitudinal growth remains significantly impaired in single ventricle patients for several years after heart transplantation.
- Despite improvements in weight gain post-HT, persistent stunting suggests underlying factors beyond SV physiology contribute to growth deficits.
- Further research is needed to address the persistent growth challenges in pediatric SV patients post-heart transplantation.
Background:
Malnutrition is common among children with single ventricle (SV) congenital heart disease (CHD). The impact of heart transplantation (HT) on nutritional status in SV patients is understudied. Our aim was to evaluate anthropometric changes in SV patients after HT, compared with those transplanted for cardiomyopathy (CM).
Methods:
We performed a single-center retrospective chart review of SV and CM patients < 18 years who underwent HT from January 01, 2010 to December 05, 2017. Wasting and stunting were defined as z-scores for weight-for-age or height-for-age ≤-2, respectively. Changes in these indices between HT and 3 years post-HT were analyzed.
Results:
Of 86 eligible patients, 28 (33%) had SV CHD and 58 (67%) had CM. Data were available at 3 years post-HT for 57 patients. At transplant, wasting was equally present in SV versus CM patients (7/28, 25% vs. 9/58, 16%, P = .22), which remained true at 3 years post-HT (2/16, 13% vs. 3/41, 7%, P = .61). At transplant, stunting was more common in SV than CM patients (17/28, 61% vs. 8/58, 14%, P < .001). At 3 years post-HT, 6 of 16 (38%) SV patients and 3 of 41 (7%) CM patients remained stunted (P = .01). Among all patients, wasting decreased from transplant to end-point (19% vs. 9%, P = .05), but stunting did not (29% vs. 16%, P = .2), such that wasting and stunting were associated at transplant (P < .001) but not at end-point (P = .17).
Conclusions:
Longitudinal growth remains impaired for several years after HT in SV patients, even when weight gain is achieved, suggesting that some factors contributing to growth impairment persist despite resolution of SV physiology.
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