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The Effect of Nutritional Status on Heart Transplant Survival in Patients under Two Years of Age

The Journal of Heart and Lung Transplantation
DOI: 10.1016/j.healun.2013.01.280
  • Medicine


Purpose Nutritional status has been shown to affect survival after heart transplant (HTx) in adults and older children. The impact of nutritional status on survival to HTx and HTx outcomes in children <2 years of age is unknown. We sought to determine the effect of nutritional status on wait-list and early post-HTx survival in this population. Methods and Materials Children 0-2 years listed for HTx from 1997-2011 were identified from the Organ Procurement and Transplantation Network database. Weight-for-height z-scores and percent ideal body weight (%IBW) were calculated at listing and at transplant. Nutritional status was categorized using the Waterlow criteria based on %IBW. The impact of nutritional status on survival to HTx was evaluated using logistic regression analysis and 1-year post-HTx survival was analyzed using Cox proportional hazard models. Results 1,653 children were included. At listing, 899 (55%) were categorized as normal nutrition status, 445 (27%) mildly wasted, 203 (12%) moderate or severely wasted, and 106 (6%) with elevated weight-to-height (W:H) ratio. Moderate or severe wasting (Adjusted Odds Ratio [AOR] 1.9; 95% Confidence Interval [CI] 1.3, 2.7) and elevated W:H ratio (AOR 1.6; CI 1.1, 2.6) were independent risk factors for wait-list mortality. Among 1,167 patients who underwent HTx, 87% (n=1,016) survived 1-year post-HTx. Pre-transplant nutritional status was not significantly associated with the need for early reoperation, dialysis, incidence of infection, stroke, rejection prior to hospital discharge, or 1-year mortality. Conclusions Moderate or severe wasting and elevated W:H ratio by Waterlow criteria are independent risk factors for wait-list mortality in patients <2 years of age. Poor nutritional status at listing does not influence post-HTx outcomes in patients who survive to HTx. Better pre-HTx nutrition for patients with moderate or severe wasting may improve waitlist survival.

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