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Obesity Is Associated With Decreased Late Survival Following Pediatric Heart Transplantation
Joshua Sparks, Jaimin Trivedi, Deborah Kozik,
Bahaaldin Alsoufi.
University of Louisville, Louisville, KY, USA.
Introduction: Obese children listed for heart transplantation (HT) face challenges related to co-morbidities, complicated pre-transplant support, donor availability/quality, long-term survival.
Methods: Using UNOS database, outcomes following listing and HT for Obese (BMI ≥95%,n=212,8%) and non-obese (n=2417,92%) children>8Y were compared.
Results: After listing, percentage transplanted and waitlist mortality were comparable (p=0.89). Obese children were more likely black, had less CHD, higher creatinine, received more MCS, accepted older donors.[Table] Waitlist durations were comparable (p=0.23). After HT, obese children had comparable primary graft dysfunction (1.4%vs1.3%,p=0.91), stroke (1.4%vs3.0%,p=0.36), dialysis (11%vs8%,p=0.18), acute rejection (12%vs15%,p=0.4), death (4%-each,p=0.96). There was significant difference in late survival (10y 47%vs64%,p=0.01) with curves diverging 4Y after HT. Survival divergence was more pronounced in those >15Y (after 2Y) and 11-15Y (after 7Y),p=0.02. Also, it was more pronounced in females(p=0.04), and non-CHD(p=0.01). On multivariable analysis, obesity was risk factor for survival (HR1.88,p=0.0003). Donor characteristics didn’t affect survival.
Conclusions: Recipient obesity is associated with decreased HT survival starting 2-7 years after HT. This seems unrelated to higher early risk or donor factors, and more likely related to metabolic syndrome affecting survival and graft loss. Opportunities exists to improve outcomes, medically or surgically. Timing of these interventions in relationship to listing and transplantation warrants exploration.
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