TY - JOUR
T1 - Subclinical Atherosclerosis in Pediatric Liver Transplant Recipients
T2 - Carotid and Aorta Intima-Media Thickness and Their Predictors
AU - Perito, Emily R.
AU - Phelps, Andrew
AU - Vase, Tabitha
AU - Feldstein, Vickie A.
AU - Lustig, Robert H.
AU - Rosenthal, Philip
N1 - Funding Information:
Supported by NIH-NIDDK K23 DK0990253-A101 (to E.P.), the American Gastroenterological Association Emmet B. Keeffe Career Development Award in Liver Disease (to E.P.), UCSF Liver Center Pilot Funding (P30 DK026743 to E.P.), UCSF, and by the NIH-National Center for Advancing Translational Sciences (UCSF-CTSI Grant UL1 TR000004). The authors declare no conflicts of interest.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/2
Y1 - 2018/2
N2 - Objective: To investigate prevalence and predictors of cardiovascular risk in pediatric liver transplant recipients using noninvasive markers of subclinical atherosclerosis: carotid intima-media thickness (cIMT) and aorta intima-media thickness (aIMT). Study design: Cross-sectional study of 88 pediatric liver transplant recipients. The cIMT and aIMT were measured by ultrasound imaging using standardized protocol. Results: Participants were 15.4 ± 4.8 years of age, and 11.2 ± 5.6 years post-transplantation. The cIMT and aIMT were both higher in males than females. In analyses adjusted for sex, age, and height, the cIMT was higher in subjects transplanted for chronic/cirrhotic liver disease and lower in subjects on cyclosporine (n = 9) than tacrolimus (n = 71). The cIMT was not associated with rejection history or current corticosteroid use. The cIMT increased with increasing diastolic blood pressure and triglycerides. The aIMT (n = 83) also increased with age, and its rate of increase post-transplant varied by age at transplantation. In adjusted analyses, aIMT was higher in subjects with glucose intolerance. In analysis of patients ≤20 years of age for whom blood pressure percentiles could be calculated (n = 66), aIMT increased with increasing diastolic blood pressure percentile (0.010 mm per 5-percentile; 95% CI, 0.000-0.021; P = 0.05). Neither the cIMT nor the aIMT was associated with obesity, systolic hypertension, or other dyslipidemia at study visit. Conclusion: Measures of long-term cardiovascular risk were associated with conditions that are more common in pediatric liver transplant recipients than nontransplanted peers, namely, diastolic hypertension and glucose intolerance. Larger, longitudinal studies are warranted to investigate whether cIMT could be useful for stratifying these patients' cardiovascular risk—and potential need for proactive intervention—during long-term follow-up.
AB - Objective: To investigate prevalence and predictors of cardiovascular risk in pediatric liver transplant recipients using noninvasive markers of subclinical atherosclerosis: carotid intima-media thickness (cIMT) and aorta intima-media thickness (aIMT). Study design: Cross-sectional study of 88 pediatric liver transplant recipients. The cIMT and aIMT were measured by ultrasound imaging using standardized protocol. Results: Participants were 15.4 ± 4.8 years of age, and 11.2 ± 5.6 years post-transplantation. The cIMT and aIMT were both higher in males than females. In analyses adjusted for sex, age, and height, the cIMT was higher in subjects transplanted for chronic/cirrhotic liver disease and lower in subjects on cyclosporine (n = 9) than tacrolimus (n = 71). The cIMT was not associated with rejection history or current corticosteroid use. The cIMT increased with increasing diastolic blood pressure and triglycerides. The aIMT (n = 83) also increased with age, and its rate of increase post-transplant varied by age at transplantation. In adjusted analyses, aIMT was higher in subjects with glucose intolerance. In analysis of patients ≤20 years of age for whom blood pressure percentiles could be calculated (n = 66), aIMT increased with increasing diastolic blood pressure percentile (0.010 mm per 5-percentile; 95% CI, 0.000-0.021; P = 0.05). Neither the cIMT nor the aIMT was associated with obesity, systolic hypertension, or other dyslipidemia at study visit. Conclusion: Measures of long-term cardiovascular risk were associated with conditions that are more common in pediatric liver transplant recipients than nontransplanted peers, namely, diastolic hypertension and glucose intolerance. Larger, longitudinal studies are warranted to investigate whether cIMT could be useful for stratifying these patients' cardiovascular risk—and potential need for proactive intervention—during long-term follow-up.
KW - atherosclerosis
KW - cardiovascular risk
KW - children
KW - liver transplantation
KW - metabolic syndrome
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U2 - 10.1016/j.jpeds.2017.10.006
DO - 10.1016/j.jpeds.2017.10.006
M3 - Article
C2 - 29224938
AN - SCOPUS:85044843650
SN - 0022-3476
VL - 193
SP - 119-127.e1
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -