Cardiovascular effects of metabolic syndrome after transplantation: convergence of obesity and transplant-related factors

Abstract

Children are at increased risk of developing metabolic syndrome (MS) after kidney transplantation, which contributes to long-term cardiovascular (CV) morbidities and decline in allograft function. While MS in the general population occurs due to excess caloric intake and physical inactivity, additional chronic kidney disease and transplant-related factors contribute to the development of MS in transplant recipients. Despite its significant health consequences, the interplay of the individual components in CV morbidity in pediatric transplant recipients is not well understood. Additionally, the optimal methods to detect early CV dysfunction are not well defined in this unique population. The quest to establish clear guidelines for diagnosis is further complicated by genetic differences among ethnic groups that necessitate the development of race-specific criteria, particularly with regard to individuals of African descent who carry the apolipoprotein L1 variant. In children, since major CV events are rare and traditional echocardiographic measures of systolic function, such as ejection fraction, are typically well preserved, the presence of CV disease often goes undetected in the early stages. Recently, new noninvasive imaging techniques have become available that offer the opportunity for early detection. Carotid intima-media thickness and impaired myocardial strain detected by speckle tracking echocardiography or cardiac magnetic resonance are emerging as early and sensitive markers of subclinical CV dysfunction. These highly sensitive tools may offer the opportunity to elucidate subtle CV effects of MS in children after transplantation. Current knowledge and future directions are explored in this review.

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

“…Traditional markers of adiposity‐associated CV risk (LVH, dyslipidemia, and hypertension) are complemented by the addition of novel markers of subclinical CV disease detected by imaging for CIMT and myocardial strain to define the composite CV outcome. Increased CIMT is a marker of early atherosclerosis and is associated with increased risk of stroke and myocardial infarction in adults . Studies show that pediatric kidney transplant recipients have higher CIMT in comparison with healthy controls .…”

“…Myocardial strain is a sensitive imaging method that is able to detect early signs of left ventricular dysfunction that are not evident by standard echocardiography. Emerging evidence indicates that subclinical left ventricular dysfunction, detected only by impaired myocardial strain, is present in children with obesity as well as in pediatric dialysis and transplant patients …”

<p>Prevalence of metabolic syndrome in dialysis and transplant patients</p>

“…In renal transplant patients, a complex interaction between metabolic syndrome and renal transplant factors was observed, as metabolic syndrome can deteriorate renal function and increase rejection rates. Moreover, transplant-related medications could further exacerbate metabolic syndrome components 5. A complex relation with metabolic syndrome can also be observed in dialysis patients.…”

Prevalence of Metabolic Syndrome and Its Components in Kidney Graft Recipients

“…The authors declare that they do not have any conflict of interests. также негативно влияет на функцию трансплантата и увеличивает вероятность его отторжения [6,7]. Однако в некоторых исследованиях показано, что распространенность МС у реципиентов трансплантата почки ниже, чем у пациентов, получающих диализную терапию, главным образом за счет снижения АД и повышения уровня ЛПВП после трансплантации почки [8].…”