Incidence and Risk Factors of Obesity in Childhood Solid-Organ Transplant Recipients

Abstract

Background. Obesity is a significant public health concern; however, the incidence post solid-organ transplantation is not well reported. Methods. This study determined the incidence and risk factors of obesity among pediatric solid-organ transplant recipients (heart, lung, liver, kidney, multiorgan) at The Hospital for Sick Children (2002–2011), excluding prevalent obesity. Follow-up occurred from transplantation until development of obesity, last follow-up, or end of study. Incidence of obesity was determined overall, by baseline body mass index, and organ group. Risk factors were assessed using Cox proportional-hazards regression. Results. Among 410 (55% male) children, median transplant age was 8.9 (interquartile range [IQR]: 1.0-14.5) years. Median follow-up time was 3.6 (IQR: 1.5-6.4) years. Incidence of obesity was 65.2 (95% confidence interval [CI]: 52.7-80.4) per 1000 person-years. Overweight recipients had a higher incidence, 190.4 (95% CI: 114.8-315.8) per 1000 person-years, than nonoverweight recipients, 56.1 (95% CI: 44.3-71.1). Cumulative incidence of obesity 5-years posttransplant was 24.1%. Kidney relative to heart recipients had the highest risk (3.13 adjusted hazard ratio [aHR]; 95% CI: 1.53-6.40) for obesity. Lung and liver recipients had similar rates to heart recipients. Those with higher baseline body mass index (z-score; 1.72 aHR; 95% CI: 1.39-2.14), overweight status (2.63 HR; 95% CI: 1.71-4.04), and younger transplant age (y; 1.18 aHR; 95% CI: 1.12-1.25) were at highest risk of obesity. Higher cumulative steroid dosage (per 10 mg/kg) was associated with increased risk of obesity after adjustment. Conclusions. Among all transplanted children at The Hospital for Sick Children, 25% developed obesity within 5-years posttransplant. Kidney recipients, younger children, those overweight at transplant, and those with higher cumulative steroid use (per 10 mg/kg) were at greatest risk. Early screening and intervention for obesity are important preventative strategies.

Physical performance after pediatric solid organ transplantation

“…Immunosuppressive medication is likely to contribute to the risk of cardiovascular morbidity by increasing the likelihood of hypertension, dyslipidemia, and diabetes mellitus 11 . A recent study among pediatric transplant recipients showed that 25% of the recipients were obese at 5 years after transplantation 12 . Physical performance evaluation should be an important part of the posttransplant follow‐up addressing the problem of low physical activity (PA) and physical deconditioning in pediatric SOT recipients.…”

“…11 A recent study among pediatric transplant recipients showed that 25% of the recipients were obese at 5 years after transplantation. 12 Physical performance evaluation should be an important part of the posttransplant follow-up addressing the problem of low physical activity (PA) and physical deconditioning in pediatric SOT recipients.…”

Malnutrition and immune cell subsets in children undergoing kidney transplantation

“…11% in liver and 6% in heart transplant recipients). 8 Obesity is known to be proinflammatory 12 and when present at the time of transplant has been associated with multiple adverse events in pediatric kidney transplantation. First, obesity has been shown to correlate with metabolic syndrome among transplant recipients with manifestations including hypertension, dyslipidemia and glucose intolerance.…”

“…13,14 Additionally, children who were overweight at baseline, or who were exposed to steroids, were most likely to develop obesity post-kidney transplantation. 8 Finally, obesity has also been associated with worse post-transplant outcomes including increases in rates of delayed graft function (DGF), acute rejection and increased hospitalizations as well as decreased graft, and patient survival. 7,[15][16][17] With regard to undernutrition, chronically ill children in general are at higher risk for undernutrition with one study finding that greater than 30% of chronically ill children attending outpatient visits are malnourished.…”

Longitudinal Changes in Cardiac Structure and Function in Pediatric Kidney Transplant Recipients

“…After kidney transplantation, children are at risk for developing obesity, diabetes, and hypertension, all of which can contribute to cardiovascular risk and are associated with LVH. 2,7,22,23 Longitudinal assessment of early cardiac remodeling in a large pediatric population will help determine whether the restoration of kidney function impacts cardiac structure and function and how to best manage cardiovascular health to mitigate long-term risk. The objective of this study was to investigate the influence of blood pressure management on the longitudinal changes in cardiac structure and function in pediatric kidney transplant recipients to determine patterns in cardiovascular remodeling following transplantation.…”