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Incidence and Risk Factors of Obesity in Childhood Solid-Organ Transplant Recipients
Bianca C Bondi1, Tonny M Banh1, Jovanka Vasilevska-Ristovska1
1Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Pediatric solid-organ transplant recipients face a significant risk of developing obesity, with 25% affected within five years. Kidney recipients, younger children, and those overweight at transplant are at highest risk, necessitating early intervention strategies.
Area of Science:
- Pediatric Transplantation
- Public Health
- Endocrinology
Background:
- Obesity is a critical public health issue with poorly documented incidence in pediatric solid-organ transplant (SOT) recipients.
- Understanding post-transplant obesity is crucial for managing long-term health outcomes in this vulnerable population.
Purpose of the Study:
- To determine the incidence and identify risk factors for new-onset obesity in pediatric SOT recipients.
- To analyze obesity development across different organ transplant groups (heart, lung, liver, kidney, multiorgan).
Main Methods:
- A retrospective study of 410 pediatric SOT recipients (2002-2011) at The Hospital for Sick Children, excluding those with pre-existing obesity.
- Follow-up until obesity development, last follow-up, or study end; incidence calculated per 1000 person-years.
- Cox proportional-hazards regression used to assess risk factors, including baseline body mass index (BMI), organ type, and steroid dosage.
Main Results:
- The overall incidence of obesity was 65.2 per 1000 person-years; overweight recipients had a significantly higher incidence (190.4 per 1000 person-years).
- Cumulative incidence of obesity reached 24.1% by 5 years post-transplant.
- Kidney recipients (aHR 3.13) faced the highest risk, followed by those with higher baseline BMI z-scores (aHR 1.72), overweight status (HR 2.63), younger transplant age (aHR 1.18), and higher cumulative steroid dosage.
Conclusions:
- Approximately 25% of pediatric SOT recipients develop obesity within five years post-transplant.
- Key risk factors include kidney transplantation, younger age at transplant, pre-transplant overweight status, and cumulative steroid exposure.
- Emphasizes the need for early obesity screening and preventative interventions in pediatric SOT patients.
Background:
Obesity is a significant public health concern; however, the incidence post solid-organ transplantation is not well reported.
Methods:
This study determined the incidence and risk factors of obesity among pediatric solid-organ transplant recipients (heart, lung, liver, kidney, multiorgan) at The Hospital for Sick Children (2002-2011), excluding prevalent obesity. Follow-up occurred from transplantation until development of obesity, last follow-up, or end of study. Incidence of obesity was determined overall, by baseline body mass index, and organ group. Risk factors were assessed using Cox proportional-hazards regression.
Results:
Among 410 (55% male) children, median transplant age was 8.9 (interquartile range [IQR]: 1.0-14.5) years. Median follow-up time was 3.6 (IQR: 1.5-6.4) years. Incidence of obesity was 65.2 (95% confidence interval [CI]: 52.7-80.4) per 1000 person-years. Overweight recipients had a higher incidence, 190.4 (95% CI: 114.8-315.8) per 1000 person-years, than nonoverweight recipients, 56.1 (95% CI: 44.3-71.1). Cumulative incidence of obesity 5-years posttransplant was 24.1%. Kidney relative to heart recipients had the highest risk (3.13 adjusted hazard ratio [aHR]; 95% CI: 1.53-6.40) for obesity. Lung and liver recipients had similar rates to heart recipients. Those with higher baseline body mass index (z-score; 1.72 aHR; 95% CI: 1.39-2.14), overweight status (2.63 HR; 95% CI: 1.71-4.04), and younger transplant age (y; 1.18 aHR; 95% CI: 1.12-1.25) were at highest risk of obesity. Higher cumulative steroid dosage (per 10 mg/kg) was associated with increased risk of obesity after adjustment.
Conclusions:
Among all transplanted children at The Hospital for Sick Children, 25% developed obesity within 5-years posttransplant. Kidney recipients, younger children, those overweight at transplant, and those with higher cumulative steroid use (per 10 mg/kg) were at greatest risk. Early screening and intervention for obesity are important preventative strategies.
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