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Serum lipid abnormalities in pediatric liver transplant patients
S V McDiarmid1, J A Gornbein, M Fortunat
1Department of Pediatrics, UCLA School of Medicine.
Insights
Pediatric liver transplant recipients frequently exhibit serum lipid abnormalities, with over half showing high cholesterol and triglyceride levels. These lipid issues may increase long-term atherosclerosis risk in children post-transplant.
Area of Science:
- Pediatric Gastroenterology
- Transplant Medicine
- Cardiovascular Risk Factors
Background:
- Serum lipid abnormalities are not well-characterized in pediatric liver transplant recipients.
- Long-term cardiovascular health is a concern for these young patients.
Purpose of the Study:
- To investigate the prevalence and patterns of serum lipid abnormalities in pediatric liver transplant recipients.
- To identify potential associations between lipid levels and clinical factors.
Main Methods:
- A longitudinal cohort review of 102 pediatric liver transplant recipients surviving over 6 months.
- Data collected included serum lipid levels (cholesterol, triglycerides), immunosuppressant drug levels and doses (cyclosporine, prednisone), and clinical parameters.
- Statistical analyses included bivariate and multivariate regression.
Main Results:
- 47% of patients had cholesterol levels > 170 mg/dl and 50% had triglyceride levels > 140 mg/dl.
- No significant association was found between lipid levels and age, obesity, sex, family history, or immunosuppressant drug levels/doses.
- Cholestasis was significantly associated with increased cholesterol and triglyceride levels (P = 0.05).
- Dietary intake of fat and cholesterol was above recommendations, and exercise patterns were suboptimal.
Conclusions:
- The majority of pediatric liver transplant patients exhibit lipid abnormalities, with over 50% having elevated cholesterol and triglycerides.
- These lipid abnormalities may predispose children to atherosclerosis later in life.
- Cholestasis is a significant factor associated with dyslipidemia in this population.
Unlabelled:
Little is known about serum lipid abnormalities in pediatric liver transplant recipients. We performed a longitudinal cohort review of 102 outpatient pediatric liver recipients surviving greater than 6 months and immunosuppressed with cyclosporine and prednisone (+/- azathioprine). The median age was 6 years, median months posttransplant 25, and male-to-female ratio 1:1.5. The average cholesterol (mean of individual means) was 177 +/- 45 mg/dl and average triglyceride level 158 +/- 71 mg/dl. The mean percent of cholesterol levels greater than 170 mg/dl and triglyceride levels greater than 140 mg/dl was 47% and 50%, respectively. Age, obesity, sex, and family history of risk factors had no significant effect on cholesterol or triglyceride levels. Bivariate regression analysis showed no meaningful association between cholesterol or triglyceride levels and cyclosporine levels, cyclosporine dose, prednisone dose, or diastolic blood pressure. Triglyceride and cholesterol neither increased nor decreased with time posttransplant. The rate of change of triglyceride or cholesterol could not be predicted by the rate of change of cyclosporine levels (or dose), or prednisone dose. We found no evidence that rises or falls in cholesterol or triglyceride levels coincided with rises or falls in either cyclosporine level or prednisone dose. Cholestasis was significantly associated with increased cholesterol and triglyceride levels (P = 0.05). A multivariate analysis was unable to predict cholesterol or triglyceride levels from three predictors: cyclosporine level, prednisone dose, and liver function. The mean dietary intake of fat and cholesterol was above RDA and exercise patterns were suboptimal in school-aged children.
Conclusions:
50% of children had a mean cholesterol greater than 75th percentile (170 mg/dl); 20% were above the 95th percentile; 56% had a mean triglyceride level greater than 140 mg/dl. By these criteria the majority of pediatric liver transplant patients have lipid abnormalities that may predispose them to atherosclerosis in later life.