Wasting or Obesity at Time of Transplant Does Not Predict Pediatric Heart Transplant Outcomes: Analysis of ISHLT Pediatric Heart Transplant Registry

Kaufman, Beth D.; Chuai, Shannon; Dobbels, Fabienne; Shaddy, Robert E.

doi:10.1016/j.healun.2009.07.020

Cited by 25 publications

(28 citation statements)

References 11 publications

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“…In liver transplantation, the risk is 14-16% and remains high long after transplantation (15,60). Obesity following cardiac transplantation occurs less frequently and is estimated at 8%, possibly because of the focus of corticosteroid withdrawal and the use of statins (61). The use of statins in other solid organ transplant recipients requires further investigation (62).…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of children after solid organ transplantation

Kim

Marks

2014

Clinics

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Solid organ transplantation has transformed the lives of many children and adults by providing treatment for patients with organ failure who would have otherwise succumbed to their disease. The first successful transplant in 1954 was a kidney transplant between identical twins, which circumvented the problem of rejection from MHC incompatibility. Further progress in solid organ transplantation was enabled by the discovery of immunosuppressive agents such as corticosteroids and azathioprine in the 1950s and ciclosporin in 1970. Today, solid organ transplantation is a conventional treatment with improved patient and allograft survival rates. However, the challenge that lies ahead is to extend allograft survival time while simultaneously reducing the side effects of immunosuppression. This is particularly important for children who have irreversible organ failure and may require multiple transplants. Pediatric transplant teams also need to improve patient quality of life at a time of physical, emotional and psychosocial development. This review will elaborate on the long-term outcomes of children after kidney, liver, heart, lung and intestinal transplantation. As mortality rates after transplantation have declined, there has emerged an increased focus on reducing longer-term morbidity with improved outcomes in optimizing cardiovascular risk, renal impairment, growth and quality of life. Data were obtained from a review of the literature and particularly from national registries and databases such as the North American Pediatric Renal Trials and Collaborative Studies for the kidney, SPLIT for liver, International Society for Heart and Lung Transplantation and UNOS for intestinal transplantation.

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Section: Introductionmentioning

confidence: 99%

Long-term outcomes of children after solid organ transplantation

Kim

Marks

2014

Clinics

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“…One found significantly longer LOS in obese patients, 33 and the other found no difference in LOS according to weight category. 30 A similar discrepancy existed with the 2 studies of patients with burns 27,39 ; however, only 1 of these adjusted for covariates in the analysis. 27 As assessed by the Newcastle-Ottawa Scale, quality scores were higher, on average, among studies reporting obesity as a significant contributor to LOS (n = 5).…”

Section: Resultsmentioning

confidence: 82%

“…17,25,26,30,32,33,39,43 Populations studied included trauma patients, patients with osteosarcoma, and 3 studies of heart transplant recipients. 30,32,33 A significant association between obesity and the incidence of infections was reported in 2 of the 8 studies, including 1 study of critically ill trauma patients 17 and 1 study of patients who underwent spinal fusion surgery. 43 The remaining 6 studies found no significant associations between obesity and infectious outcomes, although 3 of these studies did not report detailed data on the actual incidence of infections in the cohorts.…”

Section: Resultsmentioning

confidence: 99%

“…A carefully controlled, small study of children who underwent spinal fusion found obesity to be a significant and independent risk factor for surgical site infections (odds ratio, 3.1; 95% CI, 1.1–9.1; P = .04) in a multivariable regression model including hypothermia, antibiotic prophylaxis, and an underlying health status score. 43 Conversely, a large multicenter study of heart transplant recipients 30 found no significant association between obesity and the incidence of infection and accounted for more than half of the total patients reviewed with this finding. This particular analysis compared wasted, normally nourished, and obese groups, but it did not investigate the effect of confounders or covariates on the incidence of infections.…”

Section: Commentmentioning

confidence: 99%

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Influence of Obesity on Clinical Outcomes in Hospitalized Children

Bechard¹,

Rothpletz‐Puglia²,

Touger‐Decker³

et al. 2013

JAMA Pediatr

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Importance Obesity is prevalent among hospitalized children. Knowledge of the relationship between obesity and outcomes in hospitalized children will enhance nutrition assessment and provide opportunities for interventions. Objective To systematically review the existing literature concerning the impact of obesity on clinical outcomes in hospitalized children. Evidence Acquisition PubMed, Web of Science, and EMBASE databases were searched for studies of hospitalized children aged 2 to 18 years with identified obesity and at least 1 of the following clinical outcomes: all-cause mortality, incidence of infections, and length of hospital stay. Cohort and case-control studies were included. Cross-sectional studies, studies of healthy children, and those without defined criteria for classifying weight status were excluded. The Newcastle-Ottawa Scale was used to assess study quality. Results Twenty-eight studies (26 retrospective; 24 cohort and 4 case-control) were included. Of the 21 studies that included mortality as an outcome, 10 reported a significant positive relationship between obesity and mortality. The incidence of infections was assessed in 8 of the 28 studies; 2 reported significantly more infections in obese compared with nonobese patients. Of the 11 studies that examined length of stay, 5 reported significantly longer lengths of hospital stay for obese children. Fifteen studies (53%) had a high quality score. Larger studies observed significant relationships between obesity and outcomes. Studies of critically ill, oncologic or stem cell transplant, and solid organ transplant patients showed a relationship between obesity and mortality. Conclusions and Relevance The available literature on the relationship between obesity and clinical outcomes is limited by subject heterogeneity, variations in criteria for defining obesity, and outcomes examined. Childhood obesity may be a risk factor for higher mortality in hospitalized children with critical illness, oncologic diagnoses, or transplants. Further examination of the relationship between obesity and clinical outcomes in this subgroup of hospitalized children is needed.

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“…Children who are underweight at the time of transplant have been found to develop acute rejection earlier and have decreased graft survival 62 and overall survival 63 . However, in a multicenter study with more than 2300 pediatric heart transplant patients >2 years of age, morbidity and mortality outcomes did not differ between those who were wasted (23%; BMI <5th percentile) or obese (8%; >95th percentile) vs those who had a normal BMI (5th–95th percentile) at the time of transplant 64 . A 4‐year‐old girl was admitted to the hospital with edema, feeding intolerance, and decreased ventricular function noted on echocardiogram.…”

Section: Case Presentationsmentioning

confidence: 98%

Nutrition Management After Pediatric Solid Organ Transplantation

et al. 2014

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Survival rates for pediatric transplant recipients and organ grafts have increased due to improvements in surgical techniques and with immunosuppressant treatment therapies. Interdisciplinary management after pediatric organ transplantation is essential to assist not only with the complex medical issues and complications that can result from immunosuppressant therapy but also with the achievement of normal growth and development. Impaired growth is a complication frequently experienced by pediatric transplant patients. The presence or absence of impaired growth is affected by the length of illness prior to transplant, graft function, the use of corticosteroids, and the development of infectious complications after surgery. A review of posttransplant nutrition assessment, nutrition requirements, and nutrition goals is provided. In addition, a case series of experiences with nutrition management of pediatric solid organ transplant recipients is described.

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Wasting or Obesity at Time of Transplant Does Not Predict Pediatric Heart Transplant Outcomes: Analysis of ISHLT Pediatric Heart Transplant Registry

Cited by 25 publications

References 11 publications

Long-term outcomes of children after solid organ transplantation

Long-term outcomes of children after solid organ transplantation

Influence of Obesity on Clinical Outcomes in Hospitalized Children

Nutrition Management After Pediatric Solid Organ Transplantation

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