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Cardiovascular Burden Is High in Pediatric Lung Transplant Recipients
Nima Memaran1, Mareike Onnen1, Carsten Müller2
1Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
Insights
Pediatric lung transplant recipients experience significant cardiovascular damage, including arteriosclerosis and atherosclerosis. Early detection and intervention targeting identified risk factors are crucial for improving long-term outcomes.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Cardiovascular morbidity is prevalent in adult lung transplant (LTx) recipients.
- Subclinical cardiovascular damage in pediatric LTx recipients remains undescribed.
- Early indicators include increased pulse wave velocity (PWV), intima-media thickness (IMT), and left ventricular mass index (LVMI).
Purpose of the Study:
- To describe the prevalence and risk factors of subclinical cardiovascular damage in pediatric LTx recipients.
- To assess early signs of arteriosclerosis, atherosclerosis, and left ventricular hypertrophy.
Main Methods:
- Prospective longitudinal study of 47 pediatric LTx recipients.
- Annual assessments over a mean follow-up of 2.2 years (144 observations).
- Measurements included PWV, IMT, LVMI, blood pressure, and glomerular filtration rate.
Main Results:
- At inclusion, 13% had increased PWV, 30% had increased IMT, and 33% had elevated LVMI.
- Higher PWV associated with male sex, longer time post-LTx, higher diastolic blood pressure, and lower GFR.
- Higher IMT associated with male sex and lower hemoglobin; diabetes associated with higher LVMI.
Conclusions:
- Pediatric LTx recipients face a substantial and ongoing burden of subclinical cardiovascular damage.
- Cardiovascular morbidity requires attention given improving long-term LTx survival.
- Identified risk factors offer potential targets for therapeutic interventions.
Background:
Cardiovascular morbidity is common in adults after lung transplantation (LTx) but has not been described for pediatric LTx recipients. Early subclinical cardiovascular damage is reflected by increases in pulse wave velocity (PWV; indicating arteriosclerosis), intima-media thickness (IMT; indicating atherosclerosis), and left ventricular mass index (LVMI; indicating left ventricular hypertrophy).
Methods:
We annually assessed 47 pediatric LTx recipients in a prospective longitudinal study (144 observations, mean 3.1 visits/patient, range of 1-4 visits, mean follow-up 2.2 y).
Results:
At inclusion, increased PWV and IMT were detected in 13% and 30%, respectively, and elevated LVMI was detected in 33%. Higher PWV was associated with male sex, longer time since LTx, higher diastolic blood pressure, and lower glomerular filtration rate. Male sex and lower hemoglobin levels were associated with higher IMT, and the presence of diabetes was associated with higher LVMI.
Conclusions:
Pediatric LTx recipients suffer from a high and sustained burden of subclinical cardiovascular damage. In light of improving long-term outcomes, cardiovascular morbidity needs to be addressed. Our analysis identified classical and nonclassical risk factors to be associated with the measures for cardiovascular damage, which could serve as targets for intervention.
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