title: Abnormal nutrition affects waitlist mortality in infants awaiting heart transplant.
abstract: 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.
authors.affiliation: Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan. Electronic address: jgodown@med.umich.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Godown
authors.affiliation: Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Friedland-Little
authors.affiliation: Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gajarski
authors.affiliation: Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Donohue
authors.affiliation: Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
authors.forename: Kurt R
authors.initials: KR
authors.lastname: Schumacher
mesh_terms: D000367:Age Factors; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D009202:Cardiomyopathies / Q000401:mortality* / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000150:complications* / Q000503:physiopathology; D007231:Infant, Newborn; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014850:Waiting Lists; D019282:Wasting Syndrome / Q000150:complications* / Q000503:physiopathology
keywords: heart transplant; infants; nutritional status; waitlist; weight-to-height ratio