Post-Transplant Metabolic Syndrome in Pediatric Liver Transplant Recipients: Definition, Prevalence and Clinical
Maarten Buytaert1,2, Eline Braekman3, Kaat Van Overbeke4
1Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
Insights
Post-transplant metabolic syndrome (PTMS) affects 14-20% of pediatric liver transplant recipients. This condition, marked by cardiovascular risks, lacks a clear definition and management guidelines.
Area of Science:
- Pediatric Hepatology
- Transplantation Medicine
- Cardiovascular Risk Assessment
Background:
- Long-term survival after pediatric liver transplantation (LT) has improved significantly.
- Post-transplant metabolic syndrome (PTMS) is a growing concern in pediatric LT recipients, mirroring adult metabolic syndrome.
- PTMS is characterized by dyslipidemia, hypertension, impaired glucose, and obesity, increasing cardiovascular risk.
Purpose of the Study:
- To review the current understanding of PTMS in pediatric liver transplant recipients.
- To highlight the prevalence, components, and contributing factors of PTMS.
- To underscore the need for a standardized definition and management strategies for PTMS.
Main Methods:
- Review of existing literature on PTMS in pediatric LT.
- Analysis of studies reporting prevalence, risk factors, and outcomes related to PTMS.
- Synthesis of data regarding components of metabolic syndrome post-LT.
Main Results:
- PTMS prevalence in pediatric LT recipients is estimated between 14% and 20%.
- A lack of a universal definition and specific diagnostic cut-offs for PTMS components exists.
- Risk factors accumulate early post-transplant, decline, then rise long-term, with immunosuppression as a key contributor.
Conclusions:
- PTMS is a significant long-term complication in pediatric liver transplantation.
- Standardized definitions and monitoring protocols are crucial for effective PTMS management.
- Addressing PTMS is vital for improving long-term cardiovascular health in pediatric LT survivors.
Abstract:
Over the last decades, long-term survival after pediatric liver transplantation (LT) has improved substantially, highlighting the importance of long-term graft and recipient outcomes. Metabolic syndrome, a combination of components associated with increased cardiovascular risk, is a well-defined concept in the general adult population. The same components can be present after LT leading to post-transplant metabolic syndrome (PTMS). In children, PTMS is estimated to be prevalent in around 14%-20% of LT recipients. However, a univocal definition is lacking as well as consensus on specific cut-off values for the different components. The latter comprise: low HDL-cholesterol, high triglycerides (both falling under the heading of "dyslipidemia"), hypertension, impaired fasting glucose and/or impaired glucose tolerance, and (abdominal) obesity. Although most studies have a retrospective or cross-sectional nature and are of relatively small sample size, there seems to be an accumulation of risk factors in the first years after transplantation, declining thereafter and rising again in the long term. Sustained exposure to immunosuppression is identified as a major contributor, as well as accumulating general cardiometabolic risk factors throughout life.
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