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Weight Gain Trajectory Predicts Long-term Overweight and Obesity After Pediatric Liver Transplant
Sonja Marie Swenson1, Emily Rothbaum Perito2,3
1School of Medicine.
Insights
Pediatric liver transplant recipients often become overweight within one year, with nearly half affected by three years post-transplant. Early identification of overweight children is crucial for intervention and counseling.
Area of Science:
- Pediatric Gastroenterology
- Transplant Surgery
- Endocrinology
Background:
- Liver transplantation in children can lead to significant post-transplant weight changes.
- Overweight and obesity are growing concerns in pediatric populations, especially those with chronic medical conditions.
Purpose of the Study:
- To identify early predictors of long-term overweight and obesity in pediatric liver transplant recipients.
- To analyze weight and BMI trajectories in children following liver transplantation.
Main Methods:
- Retrospective review of 70 children undergoing liver transplant before age 6.
- Analysis of body mass index (BMI), weight, and height percentiles at transplant and up to 5 years post-transplant.
- Examination of BMI, weight gain, and failure-to-thrive (FTT) as predictors of later overweight/obesity.
Main Results:
- Overweight/obesity prevalence peaked at 44% at 3 years post-transplant, decreasing to 26% by 5 years.
- Children overweight/obese at 3 years were significantly more likely to be overweight/obese at transplant and 6-12 months post-transplant.
- Rapid weight gain post-transplant and failure-to-thrive at transplant did not predict later overweight/obesity.
Conclusions:
- Most pediatric liver transplant recipients experience rapid weight gain post-transplant.
- Overweight/obesity often develops within the first year, highlighting this period for risk identification.
- Early identification and counseling are recommended for children at high risk of post-transplant overweight/obesity.
Objective:
The aim of the study is to identify early predictors of long-term overweight and obesity in pediatric liver transplant recipients.
Methods:
Single-center, retrospective review of children who underwent liver transplant before age 6 years. Body mass index (BMI), weight, and height percentiles at transplant and post-transplant were calculated. BMI, weight gain trajectories, and failure-to-thrive (FTT) were examined as predictors of overweight/obesity at 3 and 5 years post-transplant.
Results:
Children (n = 70) were median 0.9 years at transplant. Median BMI percentile increased from 37 (interquartile range (IQR) 12-73) at transplant to 83 (IQR 64-97) at 12 months, with median weight percentile 47 (IQR 26-67) and height percentile 9 (IQR 2-32). Overweight/obesity prevalence peaked at 3 years post-transplant (44%). Children who were overweight/obese at 3 years post-transplant were more likely to be overweight/obese at transplant, and at 6 and 12 months post-transplant (odds ratio (OR): 9.4, P = 0.02; OR: 6.7, P = 0.013, OR: 6.4, P = 0.007, respectively). The prevalence of overweight/obesity decreased to 26% at 5 years. Rapid weight gain post-transplant did not predict overweight/obesity at 3 or 5 years. Over one-third of children who were FTT at transplant were overweight/obese at 3 or 5 years, but FTT at transplant did not increase later obesity risk.
Conclusions:
Most children gain weight rapidly after liver transplant. Nearly half of transplant recipients are overweight/obese at 3 years, but the prevalence decreases by 5 years. Those who become overweight/obese tend to do so within 1 year post-transplant, making this an important time to identify high-risk children and provide counseling.
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