Rossano Joseph W, Grenier Michelle A, Dreyer William J, Kim Jeffrey J, Price Jack F, Jefferies John L, Smith E O'Brian, Clunie Sarah K, Moulik Mousumi, Decker Jamie A, Breinholt John P, Morales David L S, McKenzie E Dean, Towbin Jeffrey A, Denfield Susan W
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
J Heart Lung Transplant. 2007 Jul;26(7):718-23. doi: 10.1016/j.healun.2007.05.001.
Obesity and cachexia are risk factors for adverse outcomes in adult transplant patients. However, little is known about the effects of body mass index (BMI) on outcomes in pediatric heart transplant patients.
Patients > 2 years of age undergoing heart transplantation from 1985 to 2004 at our institution were included in this study. BMI was assessed at the time of transplant and at 1 year post-transplant. Long-term outcomes were assessed by weight group.
The cohort included 105 patients with a mean age at transplant of 9.6 +/- 5.3 years. The mean BMI percentile at the time of transplant was 39 +/- 34, with 22 (21%) patients underweight (< 5th percentile) and 8 (8%) patients overweight (> or = 95th percentile). Among patients surviving to 1 year (n = 92), the mean BMI percentile increased to 57 +/- 33 (p < 0.05). Overall graft survival was decreased in patients underweight at transplant, mean 6.7 years (95% confidence interval [CI] 3.6 to 9.9), vs normal weight patients, mean 10.6 years (95% CI 8.8 to 12.4) (p < 0.05). Patients overweight at transplant did not have decreased graft survival. Neither low nor high BMI at 1 year post-transplant was associated with adverse outcomes. On multivariate analysis, being underweight at transplant was an independent predictor of decreased graft survival (p = 0.03).
Weight gain was nearly universal post-transplant with only 4% of patients underweight at 1 year. In the small number of patients overweight at transplant, graft survival was similar to normal-weight patients. Conversely, being underweight at transplant was an independent predictor of decreased graft survival.
肥胖和恶病质是成年移植患者不良预后的危险因素。然而，关于体重指数（BMI）对小儿心脏移植患者预后的影响知之甚少。
本研究纳入了1985年至2004年在我们机构接受心脏移植的2岁以上患者。在移植时和移植后1年评估BMI。根据体重组评估长期预后。
该队列包括105例患者，移植时的平均年龄为9.6±5.3岁。移植时的平均BMI百分位数为39±34，其中22例（21%）患者体重过轻（<第5百分位数），8例（8%）患者超重（≥第95百分位数）。在存活至1年的患者（n = 92）中，平均BMI百分位数增加至57±33（p < 0.05）。移植时体重过轻的患者总体移植物存活率降低，平均为6.7年（95%置信区间[CI] 3.6至9.9），而正常体重患者的平均移植物存活率为10.6年（95% CI 8.8至12.4）（p < 0.05）。移植时超重的患者移植物存活率没有降低。移植后1年时低BMI或高BMI均与不良预后无关。多因素分析显示，移植时体重过轻是移植物存活率降低的独立预测因素（p = 0.03）。
移植后体重增加几乎普遍存在，1年时只有4%的患者体重过轻。在移植时超重的少数患者中，移植物存活率与正常体重患者相似。相反，移植时体重过轻是移植物存活率降低的独立预测因素。
