Are children after liver transplant more prone to non‐alcoholic fatty liver disease?

Nobili, Valério; Dhawan, Anil

doi:10.1111/j.1399-3046.2008.00927.x

Cited by 7 publications

(4 citation statements)

References 19 publications

(22 reference statements)

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“…Systematic screening could improve early diagnosis (Table 6). More intensive counseling on healthy lifestyles could be provided, or immunosuppressive regimens could be modified 84. Although efforts are generally made to minimize steroid exposure in children and adolescents, this may be even more important in patients with features of metabolic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

et al. 2012

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In long-term follow-up, 18-67% of pediatric liver transplant recipients are overweight or obese— with rates varying by age and pre-transplant weight status. Similar prevalence of post-transplant obesity is seen in adults. Adults also develop post-transplant metabolic syndrome, with consequent cardiovascular disease, at rates that exceed age and gender-matched populations. Post-transplant metabolic syndrome has never been studied in pediatric liver transplant recipients—a growing population as transplant outcomes continue to improve. This paper systematically reviews the literature on each component of metabolic syndrome—obesity, hypertension, dyslipidemia, and glucose intolerance—in pediatric liver transplant recipients. Rates of obesity are similar to that of the general U.S. population of children. But hypertension, dyslipidemia, and diabetes are more common than expected for age, gender, and obesity severity in transplant recipients. Immunosuppressive medications are major contributors. Limitations of prior studies—including heterogeneous methods of diagnosis, follow-up times, and immunosuppressive regimen—hinder the analysis of risk factors. Importantly, no studies report on graft or patient outcomes associated with metabolic syndrome components after pediatric liver transplant. However, if trends in children are similar to those seen in adults, these conditions may lead to significant long-term morbidity. Further research on the prevalence, causes, and consequences of post-transplant metabolic syndrome in pediatric liver transplant is needed and ultimately will help improve long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

et al. 2012

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“…Glucocorticoids are recognized to be important in programming the hypothalamic‐pituitary axis, and it is possible that exposure to high doses in the early posttransplant period is important . This was proposed in an editorial in 2008 discussing whether children after liver transplantation were more prone to nonalcoholic fatty liver disease . Ongoing steroid use has been reported to result in both reduced BCM and increased fat mass up to 24 months after liver and kidney transplantation in adults .…”

Section: Discussionmentioning

confidence: 99%

Long-term effect of childhood liver transplantation on body cell mass

Hill

Beale

et al. 2014

Liver Transpl

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Malnutrition is common in end-stage liver disease, but a correction after transplantation is expected. Body cell mass (BCM) assessment using total body potassium (TBK) measurements is considered the gold standard for assessing nutritional status. The aim of this study was to examine the BCM and, therefore, nutritional status of long-term survivors after childhood liver transplantation. This was a longitudinal nested cohort study of patients undergoing transplantation at <18 years of age and surviving >3 years with ongoing review at our center. TBK measurements were obtained before transplantation and during long-term follow-up. BCM was calculated from TBK and was adjusted for the height raised to power p, which depended on sex (BCM/height p ). The effects of the age at transplant, linear growth impairment, a diagnosis of biliary atresia, and steroid use were assessed. Thirty-two patients (20 males) participated; 59% had biliary atresia. The median age at transplant was 2.11 years (range 5 0.38-10.92 years). Posttransplant testing was performed at a median of 7.23 years (range 5 3.28-14.99 years) when they were 10.12 years old (range 5 4.56-20.77 years). This cohort attained mean z scores for height, weight, and body mass index of 20.41 6 1.36, 20.26 6 1.14, and 0.04 6 0.99, respectively. BCM/height p was reduced before transplantation but was further reduced after transplantation (P < 0.001) despite the normalization of height and weight. Weight recovery, therefore, likely came from increased fat mass and not BCM. Linear growth impairment was associated with a greater reduction in posttransplant BCM/height p (P 5 0.02). In multivariate analyses, only an older age at transplant predicted reduced posttransplant BCM/height p (P 5 0.02). The age at transplant, sex, steroid use, and underlying diagnosis did not predict changes in BCM/height p after transplantation. In conclusion, weight recovery in long-term survivors of childhood liver transplantation is likely due to increased fat mass because BCM remains reduced. Nutritional compromise persists in long-term survivors of childhood liver transplantation. Liver Transpl 20:922-929, 2014. V C 2014 AASLD.

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“…Besides obesity, the use of immunosuppressants, corticosteroids, calcineurin inhibitors, and the presence of risk factors, including NAFLD, and kidney and bone complications have been largely implicated in PTMS development (Fig. ) .…”

Section: Discussionmentioning

confidence: 99%

“…Current opinion believes, and clinical experience demonstrates, that although the majority of transplanted children enjoy an excellent quality of life, complications can occur in the long term, even in those who have been healthy for years, or problems can develop subclinically in otherwise well children . Emerging out of the latter group of ramifications is the so‐called post‐transplant metabolic syndrome (PTMS), a concern as it is increasingly evoked or diagnosed .…”

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confidence: 99%

Pediatric post‐transplant metabolic syndrome: New clouds on the horizon

Nobili

Goyet

2013

Pediatric Transplantation

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Liver transplantation (LT) is a standard treatment for children with end-stage liver disease, standing at more than 90% survival rate after one yr, and at over a 70% survival rate after five yr. The majority of transplanted children enjoy an excellent quality of life but complications can occur in the long term, and can develop subclinically in otherwise well children; there are various underestimated nutritional and metabolic aspects, including the so-called post-transplant metabolic syndrome (PTMS). During the post-transplant period, the use of immunosuppressants, corticosteroids, calcineurin inhibitors, and the presence of risk factors, including non-alcoholic fatty liver disease (NAFLD), and kidney and bone complications have been largely implicated in PTMS development. Strategies to reduce the progression of PMTS should include careful screening of patients for diabetes, dyslipidemia, and obesity, and to support weight reduction with a carefully constructed program, particularly based on diet modification and exercise. With early identification and appropriate and aggressive management, excellent long-term health outcomes and acceptable graft survival can be achieved.

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Are children after liver transplant more prone to non‐alcoholic fatty liver disease?

Cited by 7 publications

References 19 publications

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

Long-term effect of childhood liver transplantation on body cell mass

Pediatric post‐transplant metabolic syndrome: New clouds on the horizon

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