Total Parenteral Nutrition Portends Worse One-Year Survival in Pediatric Heart Transplantation

Purpose Total parenteral nutrition (TPN) allows for caloric, electrolyte, and mineral optimization of critically ill patients prior to and after surgery. However, prolonged use of TPN is associated with increased risk of infectious complications and metabolic dysregulation that can exacerbate post-transplant complications. We sought to evaluate the impact of TPN on the 1-year survival of pediatric heart transplant (HTx) patients. Methods The UNOS and Pediatric Health Information System were queried for heart transplantations performed from 2006 to 2017. A multivariate analysis of risk factors for TPN use and known risk factors for poor transplant outcomes was performed and patients were stratified into three groups: “pre-HTx TPN” (with/without post-HTx TPN), “post-HTx TPN” only, and “no TPN” during HTx admission. Pairwise comparisons were used to assess 1-year survival between each group and to identify risk factors impacting mortality. Results A total of 2,812 patients were identified, 1,410 (50.1%) had either pre-HTx TPN (N=970) or post-HTx TPN (N=440), while 1,402 (49.9%) patients received no TPN. Post-HTx TPN patients had significantly worse 1-year survival (85.5%) compared to both pre-HTx TPN and no TPN groups [89.2% and 93.3%, respectively, p≤0.001; (Figure)]. On multivariate analysis, post-HTx TPN group was twice as likely to die within 1 year as no TPN group (OR 2.2, CI 95% 1.5-3.2). Infants, ECMO, eGFR Conclusion TPN supplementation prior to transplantation portends a significantly worse 1-year survival, whereas post-operative TPN has even a stronger association with negative post-transplant outcomes. outcomes.