Post-Transplant Metabolic Syndrome in Pediatric Liver Transplant Recipients-Contributors, Screening, and Management

Over the last decades, long-term survival after pediatric liver transplantation has improved substantially, highlighting the importance of long-term graft and recipient outcomes. About one in five pediatric liver transplant recipients will develop post-transplant metabolic syndrome (PTMS), a combination of cardiovascular risk factors increasing morbidity and mortality. In contrast to the classical metabolic syndrome (MetS), it is not always characterized by (abdominal) obesity. There are several contributing factors, among which sustained exposure to immunosuppression is a major contributor. As subclinical target organ damage is already present in childhood, cardiometabolic risk factors must be actively sought for and a structured approach including nephrological, endocrinological, and cardiological assessment is necessary. This work provides an overview of the existing literature on screening and management of post-transplant metabolic syndrome and its components. Despite consensus guidelines lacking, a patient-centered, multidisciplinary approach from the transplant team to the primary care providers is crucial to enhance long-term, meaningful survival of pediatric liver transplant recipients.