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Cardiovascular Risk Assessment in Pediatric Liver Transplant Patients
Arianna Amália Dégi1, Adrienn Bárczi1, Dolóresz Szabó1
1First Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Insights
Cardiovascular risk factors like obesity and hypertension are prevalent in children over five years post-liver transplant (LT). Immunosuppression type influences body fat and lipid levels, highlighting the need for long-term monitoring.
Area of Science:
- Pediatric Cardiology
- Transplant Medicine
- Clinical Research
Background:
- Cardiovascular diseases are a major cause of mortality in adult liver transplant (LT) recipients.
- Data on cardiovascular risk factors in pediatric LT recipients are limited.
- This study addresses the gap in understanding post-transplant cardiovascular health in children.
Purpose of the Study:
- To assess the prevalence of cardiovascular risk factors in children after liver transplantation.
- To identify signs of cardiovascular impairment in pediatric LT recipients.
- To analyze the influence of immunosuppression regimens on cardiovascular health.
Main Methods:
- Evaluated 42 pediatric LT recipients (mean age 9.93 years).
- Assessed body composition, lipid profiles, glycemic control, blood pressure, and arterial stiffness (aortic pulse wave velocity).
- Compared outcomes between patients on tacrolimus (TAC) and cyclosporine (CyA) immunosuppression.
Main Results:
- 18% of children were overweight or obese.
- 40% had borderline to high lipid values; 19% had hypertension.
- Tacrolimus-associated with higher body fat; Cyclosporine-associated with higher cholesterol.
- 12% showed increased arterial stiffness; 50% had reduced kidney function.
Conclusions:
- Pediatric LT recipients >5 years post-transplant exhibit increased body fat, hypertension, dyslipidemia, and arterial stiffness.
- Cardiovascular risk factors are partly related to the immunosuppression regimen.
- Long-term follow-up is crucial to determine the impact on cardiovascular health and survival.
Objectives:
Cardiovascular (CV) diseases play a leading role in the mortality of adult liver transplant (LT) recipients. However, data regarding CV risk factors in children after LT remain sparse. The present study assessed the presence of CV risk factors and signs of CV impairment in LT children.
Methods:
A total of 42 LT recipients (21 men, age 9.93 ± 3.57 years) were studied. Body composition [body mass index standard deviation score, percentage of body fat (by bioimpedance analysis)], lipid profiles, glycemic control, blood pressure, and arterial stiffness [assessed by aortic pulse wave velocity (PWV)] were evaluated. The effect of different treatment modalities [tacrolimus (TAC) (n = 30) or cyclosporine (CyA) (n = 11)] was also analyzed.
Results:
Almost 18% of children were overweight or obese. Patients on TAC had a significantly higher body fat mass and percentage of body fat compared with the CyA group (P < 0.02). Borderline to high lipid values were present in 40% of patients. Children on CyA had higher serum cholesterol levels compared to TAC (P < 0.004). Nineteen percent of patients had hypertension. Half of the patients had glomerular filtration rate values <90 mL/min/1.73 m, whereas PWV values were above the 95th percentile in 12%.
Conclusions:
Increased body fat, chronic kidney disease, high lipid content, hypertension, and increased arterial stiffness are already present and are in part related to the type of immunosuppression regimen in LT children >5 years following transplantation. Long-term follow-up is needed to evaluate their impact on CV health and survival.
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S1 (First Heart Sound)-
S1 is made by the closure of the mitral and tricuspid valves (atrioventricular valves), marking the beginning of systole.
S2 (Second Heart Sound)-
S2 is made by the closure of the aortic and pulmonic valves (semilunar valves), marking the end of the systole.