Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Thomas Jefferson University, Philadelphia, Pennsylvania.
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
J Heart Lung Transplant. 2015 Nov;34(11):1462-70. doi: 10.1016/j.healun.2015.05.023. Epub 2015 Jun 10.
In adults, low body mass index (BMI) and high BMI have been associated with increased mortality after heart transplantation. Studies of BMI in children with heart failure have had inconsistent results.
The United Network for Organ Sharing database has 4,035 listings for primary, isolated heart transplant in patients 3 to 18 years old (1995-2012). BMI percentile-for-age (BMI%) was calculated, and patients were stratified based on BMI% into 4 groups: underweight (BMI% <5, n = 701 [17.4%]), normal weight (BMI% 5-84, n = 2,321 [57.5%]), overweight (BMI% 85-94, n = 440 [10.9%]), or obese (BMI% ≥95, n = 573 [14.2%]). Outcomes of patients on the waitlist and after transplantation were assessed.
Unadjusted early waitlist mortality was highest in underweight patients (16.7%) compared with normal-weight (11.4%), overweight (10.9%), and obese (12.9%) patients (p = 0.04). In multivariable analysis, underweight patients had elevated risk-adjusted waitlist mortality (odds ratio = 1.4, 95% confidence interval = 1.0-2.2). Unadjusted post-transplant mortality did not differ across BMI% groups (underweight, 5.7%; normal weight, 5.4%; overweight, 5.5%; obese, 5.8%), but obese patients had borderline higher risk-adjusted post-transplant mortality (odds ratio = 1.7, 95% confidence interval = 1.0-3.0). Change in BMI% while waiting did not affect post-transplant mortality.
Children listed for heart transplant are commonly either underweight or obese. Underweight patients have high risk-adjusted mortality before transplantation, whereas obese patients have borderline higher adjusted post-transplant mortality.
在成年人中，低体重指数（BMI）和高 BMI 与心脏移植后死亡率增加有关。心力衰竭儿童 BMI 的研究结果不一致。
美国器官共享联合网络数据库中有 4035 例年龄在 3 至 18 岁（1995-2012 年）的原发性孤立心脏移植患者的记录。计算了 BMI 年龄百分位数（BMI%），并根据 BMI%将患者分为 4 组：体重不足（BMI%<5，n=701[17.4%]）、正常体重（BMI%5-84，n=2321[57.5%]）、超重（BMI%85-94，n=440[10.9%]）或肥胖（BMI%≥95，n=573[14.2%]）。评估了等待移植名单上和移植后的患者结局。
未经调整的早期等待名单死亡率在体重不足的患者中最高（16.7%），而正常体重、超重和肥胖患者的死亡率分别为（11.4%）、（10.9%）和（12.9%）（p=0.04）。在多变量分析中，体重不足的患者等待名单死亡率风险调整后升高（比值比=1.4，95%置信区间=1.0-2.2）。BMI%组之间的未调整移植后死亡率没有差异（体重不足组为 5.7%，正常体重组为 5.4%，超重组为 5.5%，肥胖组为 5.8%），但肥胖患者移植后死亡率风险调整后略高（比值比=1.7，95%置信区间=1.0-3.0）。等待期间 BMI%的变化并不影响移植后的死亡率。
接受心脏移植的儿童通常体重不足或肥胖。体重不足的患者在移植前死亡率高，而肥胖患者调整后移植后死亡率略高。
