Subclinical Atherosclerosis in Pediatric Liver Transplant Recipients: Carotid and Aorta Intima-Media Thickness and Their Predictors

Abstract

Measures of long-term cardiovascular risk were associated with conditions that are more common in pediatric liver transplant recipients than nontransplanted peers, namely, diastolic hypertension and glucose intolerance. Larger, longitudinal studies are warranted to investigate whether cIMT could be useful for stratifying these patients' cardiovascular risk-and potential need for proactive intervention-during long-term follow-up.

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

“…Elevated IMT, compatible with nascent atherosclerosis, was present in 57% of children in our cohort. This frequency is in line with the recently published study by Perito et al No exact prevalence of pathological IMT is reported in this study. However, graphic presentation of the study data suggests a prevalence of approximately 50%.…”

“…Although a relevant CV burden has been described in children after kidney transplantation (12,13) and, more recently, in children after hematopoietic stem cell transplantation, (14) data on the development of CV morbidity in pediatric LT recipients are still scarce. (15)(16)(17) Carotid intima-media thickness (IMT) and aortic pulse wave velocity (PWV) are established pediatric markers for subclinical CV target organ damage (TOD). (18) IMT reflects atherosclerosis, the development of atheromatous deposits in the arterial wall.…”

“…Although Siirtola et al could not find a difference in IMT between pediatric transplant recipients (n = 9) and controls, (15) Roblin et al described IMT >2 standard deviation scores (SDSs) in 7 out of 31 patients. (16) In the largest case series to date, Perito et al described chronic and cirrhotic liver disease and glucose intolerance as RFs for increased IMT in 88 children after LT. (17) No data on PWV have been published yet in pediatric LT recipients.…”

“…Given the exposure to additional RFs, such as immunosuppression, in children who have received transplants, we have to assume that subclinical CV changes are already present in this population and contribute to increased morbidity and mortality once they reach adulthood. Although a relevant CV burden has been described in children after kidney transplantation and, more recently, in children after hematopoietic stem cell transplantation, data on the development of CV morbidity in pediatric LT recipients are still scarce …”

Diabetes mellitus in pediatric solid organ recipients without and with cystic fibrosis: An analysis from the German-Austrian diabetes database (Diabetes Patienten Verlaufsdokumentation)

“…Hyperglycemia and diabetes development in SOT is associated with a higher percentage of cardiovascular risk factors . In our study, diabetes‐specific data such as HbA1c and insulin dose were comparable between SOT and non‐SOT patients with diabetes.…”