Severe obesity increases risk of graft loss in pediatric heart transplantation

There is a pressing need to improve assessment and treatment of obesity in children with end-stage heart failure awaiting transplantation. Although early survival rates are comparable, med- and long-term outcomes are concerning for severely obese children after heart transplant. Though unclear, the pathophysiologic effects are likely due to accelerated allograft vasculopathy from the metabolic derangement of obesity. Particularly in older children and adolescents, severe obesity should be considered a modifiable risk factor and aggressively managed before and after transplantation.