Lipid profile and cardiovascular risk factors in pediatric liver transplant recipients
Emilie Roblin1, Jérôme Dumortier2,3, Mathilde Di Filippo4,5
1Service d'Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.
Insights
Pediatric liver transplant (LT) recipients show few cardiovascular risk factors long-term. Instead of high cholesterol, many experience low LDL-cholesterol, possibly due to immunosuppressive therapy.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Cardiovascular Research
- Transplantation Medicine
Background:
- Cardiovascular diseases pose significant long-term risks for adult liver transplant (LT) recipients.
- Assessing cardiovascular risk factors (CVRF) in pediatric LT survivors is crucial for long-term outcomes.
Purpose of the Study:
- To evaluate cardiovascular risk factors (CVRF), lipid abnormalities, and atherosclerosis (carotid intima-media thickness, c-IMT) in children over 10 years post-pediatric LT.
Main Methods:
- Retrospective analysis of 31 children who underwent LT between 1990-2000.
- Median follow-up of 11.9 years.
- Assessment of CVRF, lipid profiles, and c-IMT.
Main Results:
- Obesity and treated hypertension were rare (9.7% each); no patients were smokers or diabetic.
- Elevated total cholesterol (TC) and triglycerides (TG) were infrequent (6.5%).
- Low LDL-cholesterol (58.1%), HDL-cholesterol (25.8%), apolipoprotein B (40%), and apolipoprotein A1 (20%) were common. Tacrolimus use correlated with lower LDL-C and apolipoprotein B compared to Cyclosporine A (CsA).
Conclusions:
- Pediatric LT patients exhibit a low prevalence of traditional CVRF.
- Hypocholesterolemia, particularly low LDL-C, is more prevalent than hyperlipidemia.
- Immunosuppressive therapy, specifically tacrolimus, may contribute to altered lipid profiles in these patients.
Abstract:
Cardiovascular diseases induce long-term morbidity and mortality of adult LT recipients. The aim of this retrospective study was to assess CVRF, lipid abnormalities, and atherosclerosis (appraised by c-IMT), more than 10 yr after pediatric LT. Thirty-one children who underwent LT between December 1990 and December 2000 were included. Median age at LT was 14 months (range 4-64), and median follow-up after LT was 11.9 yr (range 9.0-17.3). In our cohort, obesity (9.7%) and treated hypertension (9.7%) were rare. None of the patients was smoker or diabetic. High TC and TG were both observed in 6.5% of the patients. The mean c-IMT for male patients was 1.22 ± 1.55 and 1.58 ± 1.23 mm in female patients. Seven patients (22%) had a mean c-IMT above +2 s.d. Values below the 5th percentile were noted for LDL-cholesterol (58.1%), HDL-cholesterol (25.8%), apolipoprotein B (40%), and apolipoprotein A1 (20%). LDL-cholesterol and apolipoprotein B levels were significantly lower in patients treated by tacrolimus in comparison with CsA (p < 0.05). In conclusion, our results suggest that pediatric LT patients do not present significant CVRF; moreover, instead of hyperlipidemia, hypocholesterolemia (LDL-C) is frequent and immunosuppressive therapy is probably the cause.
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