Wasting or obesity at time of transplant does not predict pediatric heart transplant outcomes: analysis of ISHLT pediatric heart transplant registry.
BACKGROUND
Body mass index (BMI) both before and after heart transplant (HT) is used to risk stratify in adult HT. Single-center studies identify BMI as a potential predictor of outcome after HT in children; large-scale analyses in pediatric HT have not been performed.


METHODS
The ISHLT pediatric heart transplant registry was queried for HT recipients >2 years old between 1996 and 2006 with data for BMI percentile (BMI%ile) at HT. Survival and morbidity rates post-HT were compared between BMI%ile cohorts defined as: wasted, <5th BMI%ile; normal, 5th to 95th BMI%ile; and obese, >95th BMI%ile at HT.


RESULTS
Data from 2,333 pediatric HT patients were available for analysis. Incidence of abnormal BMI%ile at HT was: wasted = 23% and obese = 8%. Wasting and obesity were similar in patients with congenital or cardiomyopathic diagnoses. Wasted or obese patients at HT did not differ from patients with normal BMI in survival on Kaplan-Meier or multivariate analyses. There were no significant differences in pre-, peri- or post-operative adverse events between patients with wasting or obesity and those with normal BMI%ile at HT.


CONCLUSIONS
In contrast to adults, abnormal body mass at time of transplant was not associated with decreased survival in pediatric HT recipients. Potential pediatric transplant candidates should not be excluded based on the perception that wasting or obesity will increase the risk of adverse outcomes.
Pediatric Heart Transplant Program, Department of Pediatrics, School of Medicine, University of Pennsylvania, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA. kaufmanb@email.chop.edu
Beth D
BD
Kaufman
Shannon
S
Chuai
Fabienne
F
Dobbels
Robert E
RE
Shaddy
D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D019282:Wasting Syndrome / Q000150:complications* / Q000453:epidemiology