Cardiometabolic risks vary by weight status in pediatric kidney and liver transplant recipients: A cross‐sectional, single‐center study in the USA

Abstract

There is an increasing need to understand long-term metabolic changes and resultant comorbidities because life expectancy is increasing after pediatric kidney and liver transplants. We evaluated differences in classic and novel cardiometabolic biomarkers among obese and normal weight adolescent transplant recipients. We enrolled a total of 80 adolescent (mean±SD, 14.8 years ±3.0) transplant recipients (63 kidney, 17 liver) with mean duration from transplantation of 6.0 (±4.1) years. Among kidney transplant recipients, overweight and obese individuals had higher leptin (16.7 vs 7.5 μg/mL, P<.001), lower HDL (1.1 vs 1.3 mmol/L, P=.02), higher free fatty acid (0.6 vs 0.5 mmol/L, P=.03), higher apoB-to-apoA1 ratio (0.8 vs 0.6, P=.03), and higher glucose (5.8 vs 4.3 mmol/L, P=.03) concentrations compared to normal weight individuals. Regardless of obesity status, over half of all participants (57.5%) were considered at high cardiometabolic risk using consensus guidelines, and this was more pronounced for kidney transplant recipients (61.9%). Post-transplantation adolescents have increased cardiometabolic risk characterized by traditional risk factors of obesity and diabetes. The presence of obesity significantly worsens biomarkers of cardiometabolic risk. Future studies should explore whether treatment of obesity can improve the health and long-term outcomes for children undergoing solid organ transplant.

Comparison of BMI, waist circumference, and waist‐to‐height ratio for identification of subclinical cardiovascular risk in pediatric kidney transplant recipients

“…Obese transplant recipients who were obese by WHr were also noted to have elevated leptin levels compared with lean transplant recipients. This finding is in agreement with that of He et al, who demonstrated higher leptin levels in pediatric kidney transplant recipients with obesity. Elevated leptin is a biomarker for increased CV risk due to the hormone's proatherogenic effects that are associated with hypertension, oxidative stress, endothelial dysfunction, and subsequent vascular dysfunction …”

Physical function in children and adolescents pre‐ and 1‐year post‐liver transplant

“…Although the association between lower motor proficiency in children who are overweight or obese is established in the general population, 39,40 it is of particular concern in children post-LT, as they are at a higher risk for clustering of metabolic risk factors. 5 In healthy children, motor proficiency has been associated with higher levels of PA, 11,41 a key intervention for lowering the risk of cardiometabolic disease. 6 Our results highlight the need to address motor proficiency post-LT, including strength, speed, agility, and balance activities, to help reduce the risk of cardiometabolic morbidity in this population.…”

“…Additionally, higher weight z ‐scores were associated with lower scores on strength, balance and running speed and agility measures. Although the association between lower motor proficiency in children who are overweight or obese is established in the general population, 39,40 it is of particular concern in children post‐LT, as they are at a higher risk for clustering of metabolic risk factors 5 . In healthy children, motor proficiency has been associated with higher levels of PA, 11,41 a key intervention for lowering the risk of cardiometabolic disease 6 .…”

“…The medical course post-LT includes the burden of immunosuppressive therapy and increased risk of cardiometabolic comorbidities. [2][3][4][5] Physical activity (PA), exercise, and other healthy lifestyle behaviors play an important role in the physical and psychosocial health of all children and can help prevent and treat many of the comorbidities associated with transplantation. 6 Research has shown that children post-LT report lower levels of physical function, 7 have reduced cardiorespiratory fitness, 8,9 and are not as physically active compared to healthy peers.…”

“…With improved survival rates, 1 there is a need to examine functional outcomes and long‐term quality of life. The medical course post‐LT includes the burden of immunosuppressive therapy and increased risk of cardiometabolic comorbidities 2–5 . Physical activity (PA), exercise, and other healthy lifestyle behaviors play an important role in the physical and psychosocial health of all children and can help prevent and treat many of the comorbidities associated with transplantation 6 .…”