Cardiovascular risk factors and cardiac disorders in long‐term survivors of pediatric liver transplantation

Abstract

The MetS and cardiovascular disease are leading causes of late morbidity in adult liver transplantation recipients; however, limited data are available in pediatric liver transplantation. A single-center retrospective review was undertaken for patients who had a liver transplantation before 18 yr of age and were >5 yr post-transplantation, to study the prevalence of MetS, its components, and cardiac disorders. Fifty-eight patients were included in the study with a mean age at transplantation of 6.3 ± 6.1 yr and mean follow-up of 14.1 ± 6.0 yr. Of the study group, 41.4% were overweight or obese, with ongoing prednisone use and increased duration of follow-up being significant risk factors. Fifty-three patients had sufficient data for determining MetS, which was present in 17% of the patients. Although the prevalence of MetS is low in pediatric liver transplant recipients, it is associated with CKD and prednisone therapy (p < 0.05). Echocardiography data were available for 23 patients, of whom 43.4% had LVH and 13% had evidence of PH. The spectrum of cardiac disorders in this population is much wider than in adults.

Metabolic Syndrome Components After Pediatric Liver Transplantation: Prevalence and the Impact of Obesity and Immunosuppression

“…(29) The high prevalence of low HDL seen in our cohort has been observed in other cohorts of pediatric LT recipients; (3, 9) this will be an important topic for future study, as low HDL in children is associated with poor VLDL and triglyceride clearance. The apparent protective effect of LT against other dyslipidemias has been reported in pediatric cohorts (3, 18) but not in adults.…”

“…(3,9,10) However, these reports are largely based on data collected sporadically during clinical care rather than systematically for research purposes and have not included matched control groups. Furthermore, pediatric LT recipients do not typically undergo rigorous evaluation for pre-diabetes, an important component of metabolic syndrome tied to long-term morbidity.…”

High Burden of Subclinical Cardiovascular Target Organ Damage After Pediatric Liver Transplantation

“…We found left ventricular hypertrophy in 11% of our patients. Published reports on left ventricular hypertrophy in children who have undergone LT describe variable frequencies, ranging from 0% to 43% . Small sample sizes and a huge variability in follow‐up time after transplantation render a direct comparison of these studies difficult.…”

“…Asymptomatic interventricular septal hypertrophy and early diastolic dysfunction have been described, (21) whereas other studies did not find any differences in echocardiographic parameters between children after LT and healthy controls. (22) Baskar et al demonstrated left ventricular hypertrophy in 10 out of 23 patients >5 years after LT. (23) No large-scale prospective studies that correlate cardiac function and morphometry with other CV RFs have been published in the context of pediatric LT to date.…”

Center variation in screening for and management of metabolic syndrome in pediatric liver transplant recipients: A survey of SPLIT centers

“…We have recently shown that pediatric liver transplant recipients have a higher risk of pre‐hypertension and hypertension, impaired glucose tolerance (pre‐diabetes), and low HDL than matched peers, even after controlling for obesity and corticosteroid use . In long‐term follow‐up of these children, the prevalence of PTMS, indicating 3 or more of the diagnostic features, is estimated to be 14%‐20% . These conditions are identifiable in the pre‐clinical stage, and early identification with active management may prevent long‐term consequences.…”