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

Abstract

Introduction PTMS—a clustering of hypertension, dyslipidemia, glucose intolerance/diabetes, and obesity—is increasingly recognized as a contributor to long‐term morbidity after transplant. We sought to describe pediatric liver transplant center protocols and provider practices in screening for and managing these conditions. Methods Cross‐sectional survey of pediatric liver transplant providers from centers that participate in Studies of Liver Transplantation (SPLIT). Results Of 49 survey respondents from 39 centers, 64% were hepatologists or surgeons, 18% nurses/NPs/PAs, 12% coordinators, and 4% other. All providers felt that pediatric liver transplant recipients should be routinely screened for PTMS components. For each condition, at least 70% felt that the liver transplant team should be primarily responsible for routine screening. For each condition, at least 30% of providers reported that their center had no standardized protocol for screening. For diagnostic evaluation and initial management, >60% of providers reported that their center had no standardized protocol for glucose intolerance/diabetes, dyslipidemia, or obesity. Almost 40% had no standardized workup or initial management protocol for hypertension or chronic kidney disease. Of centers that did have screening or workup protocols, most were based on existing center practice, provider consensus, or informal review of published evidence. Screening tools, treatment steps, and thresholds for referral to another specialist varied widely. Conclusions Transplant providers intend to screen for and initiate management of PTMS components in these children, but protocols and practices vary substantially. This highlights opportunities for multi‐center collaboration on protocols or interventions to improve screening and management.

Malnutrition in Pediatric Chronic Cholestatic Disease: An Up-to-Date Overview

“…PTMS, influenced by weight gain and drug-induced hyperlipidemia and diabetes, is a crucial factor associated with the development of de novo NAFLD in liver transplant recipients [ 144 ]. Guidelines from the American Association for the Study of Liver Disease and the American Society of Transplantation recommend annual screening for obesity, hypertension, dyslipidemia, and diabetes mellitus with physical examination and fasting blood tests [ 145 , 146 ]. For this reason, it is essential to identify and test interventions to improve the screening and management of PTMS in order to improve long-term outcomes.>…”

Kidney disease in children with heart or liver transplant

“…There is considerable center-to-center variation in screening protocols for hypertension in these patients [77]. Given all the risk factors for hypertension, heart and liver transplant recipients should have routine monitoring of their blood pressure by their primary transplant team, with appropriate technique (manual office measurement and, when available, 24-h ABPM) and with reference to the most updated pediatric hypertension guidelines [78].…”

Monitoring Practices After Pediatric Liver Transplantation

“…At present, however, there are no established evidence-based guidelines validating best monitoring practices after successful pediatric LT (5)(6)(7). This has resulted in variations in clinical practice, as has been demonstrated in immunization practices and screening for metabolic syndrome in pediatric LT recipients (8,9), with the potential for unnecessary testing/procedures, higher resource utilization and costs, and poorer health outcomes.…”