Obesity and dyslipidemia predict cardiac allograft vasculopathy and graft loss in children and adolescents post-heart transplant: A PHTS multi-institutional analysis.
CAV
PHTS
Pediatric heart transplant
cardiometabolic
dyslipidemia
obesity
preventative
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
03
01
2022
received:
09
04
2021
accepted:
24
01
2022
pubmed:
6
2
2022
medline:
14
7
2022
entrez:
5
2
2022
Statut:
ppublish
Résumé
Obesity and dyslipidemia afflict children of all ages. We explored the prevalence of obesity and dyslipidemia in pediatric heart transplant (HT) recipients and its effects on cardiac allograft vasculopathy (CAV) and survival. This study included primary HT recipients (≤18 years) transplanted between 01/1996 and 12/2018 included in the Pediatric Heart Transplant Society database. Obesity was categorized according to WHO/CDC guidelines and dyslipidemia according to the National Cholesterol Education Program. Kaplan-Meier analyses for CAV and graft loss stratified for BMI and lipid panels were generated and risk factors identified using multivariate analyses. Among 6291 HT patients (median age [range] at HT = 4.3 [0.6-12.8] years; 45% Female; 68% White), 56% had a normal BMI at HT. Obese patients at HT had an increased risk for graft loss (HR 1.19, 95% CI 1.01-1.4, p = .04). Poor total cholesterol (TC), LDL-C, and TG were associated with the risk of both CAV (HR 1.79, p < .0001; HR 1.65, p = .0015; HR 1.53, p < .0001, respectively) and graft loss (HR 1.58, p = .0008; HR 1.22, p = .04; HR 1.43, p = .0007, respectively). Pediatric patients who are obese at the time of HT and dyslipidemic at 1 year post-HT are at an increased risk for CAV and graft loss. Preventative interventions may reduce morbidity and mortality among this cohort.
Sections du résumé
BACKGROUND
Obesity and dyslipidemia afflict children of all ages. We explored the prevalence of obesity and dyslipidemia in pediatric heart transplant (HT) recipients and its effects on cardiac allograft vasculopathy (CAV) and survival.
METHODS
This study included primary HT recipients (≤18 years) transplanted between 01/1996 and 12/2018 included in the Pediatric Heart Transplant Society database. Obesity was categorized according to WHO/CDC guidelines and dyslipidemia according to the National Cholesterol Education Program. Kaplan-Meier analyses for CAV and graft loss stratified for BMI and lipid panels were generated and risk factors identified using multivariate analyses.
RESULTS
Among 6291 HT patients (median age [range] at HT = 4.3 [0.6-12.8] years; 45% Female; 68% White), 56% had a normal BMI at HT. Obese patients at HT had an increased risk for graft loss (HR 1.19, 95% CI 1.01-1.4, p = .04). Poor total cholesterol (TC), LDL-C, and TG were associated with the risk of both CAV (HR 1.79, p < .0001; HR 1.65, p = .0015; HR 1.53, p < .0001, respectively) and graft loss (HR 1.58, p = .0008; HR 1.22, p = .04; HR 1.43, p = .0007, respectively).
CONCLUSIONS
Pediatric patients who are obese at the time of HT and dyslipidemic at 1 year post-HT are at an increased risk for CAV and graft loss. Preventative interventions may reduce morbidity and mortality among this cohort.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14244Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Services U.S.D.o.H.a.H. Healthy People 2020. 2010. http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx. Accessed 11 July 2019.
Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315(21):2292-2299.
Pahl E, Naftel DC, Kuhn MA, et al. The impact and outcome of transplant coronary artery disease in a pediatric population: a 9-year multi-institutional study. J Heart Lung Transplant. 2005;24(6):645-651.
Kapadia SR, Nissen SE, Ziada KM, et al. Impact of lipid abnormalities in development and progression of transplant coronary disease: a serial intravascular ultrasound study. J Am Coll Cardiol. 2001;38(1):206-213.
Corderofort A, Gavira J, Alegriabarrero E, et al. Prevalence of metabolic syndrome in heart transplant patients: role of previous cardiopathy and years since the procedure-the TRACA study. J Heart Lung Transplant. 2006;25(10):1192-1198.
Kindel SJ, Law YM, Chin C, et al. Improved detection of cardiac allograft vasculopathy: a multi-institutional analysis of functional parameters in pediatric heart transplant recipients. J Am Coll Cardiol. 2015;66(5):547-557.
Pahl E. Statins in the prevention of transplant coronary artery disease: in pediatric heart recipients. Pediatr Transplant. 2007;11(5):459-460.
Grummer-Strawn LM, et al. Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Recomm Rep. 2010;59(RR-9):1-15.
Ogden CL, Fryar CD, Martin CB, et al. Trends in obesity prevalence by race and hispanic origin-1999-2000 to 2017-2018. JAMA. 2020;324(12):1208-1210.
Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128(15):1689-1712.
Gallagher D, Andres A, Fields DA, et al. Body composition measurements from birth through 5 Years: challenges, gaps, and existing & emerging technologies-A National Institutes of Health workshop. Obes Rev. 2020;21(8):e13033.
Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(Suppl 4):S164-S192.
WHO. Nutrition Landscape Information System Country Profile Indicators: Interpretation Guide. WHO; 2010.
WHO. Report of the Commission on Ending Childhood Obesity. WHO; 2016.
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128(Suppl 5):S213-S256.
Bogle C, Perak AM, Wilkens SJ, et al. Cardiovascular Health in pediatric heart transplant recipients, in International Society for Heart and Lung Transplantation 39th Annual Meeting and Scientific Sessions. Orlando, FL. 2019. https://cslide#x02010;us.ctimeetingtech.com/ishlt2019/attendee/person/987. Accessed 4 March 2019.
Rossano JW, Grenier MA, Dreyer WJ, et al. Effect of body mass index on outcome in pediatric heart transplant patients. J Heart Lung Transplant. 2007;26(7):718-723.
Williams J, Lund L, Lamanca J, et al. Excessive weight gain in cardiac transplant recipients. J Heart Lung Transplant. 2006;25(1):36-41.
Ryan TD, Zafar F, Siegel RM, et al. Obesity class does not further stratify outcome in overweight and obese pediatric patients after heart transplantation. Pediatr Transplant. 2018;22(2):e13161.
Seipelt IM, Crawford SE, Rodgers S, et al. Hypercholesterolemia is common after pediatric heart transplantation: initial experience with pravastatin. J Heart Lung Transplant. 2004;23(3):317-322.
Chin C, Rosenthal D, Bernstein D. Lipoprotein abnormalities are highly prevalent in pediatric heart transplant recipients. Pediatr Transplant. 2000;4(3):193-199.
Armstrong AK, Goldberg CS, Crowley DC, et al. Effect of age on lipid profiles in pediatric heart transplant recipients. Pediatr Transplant. 2005;9(4):523-530.
Chen AC, Rosenthal DN, Couch SC, et al. Healthy hearts in pediatric heart transplant patients with an exercise and diet intervention via live video conferencing-Design and rationale. Pediatr Transplant. 2019;23(1):e13316.
Singh T, Naftel D, Webber S, et al. Hyperlipidemia in children after heart transplantation. J Heart Lung Transplant. 2006;25(10):1199-1205.
Hathout EH, Chinnock RE, Johnston JK, et al. Pediatric post-transplant diabetes: data from a large cohort of pediatric heart-transplant recipients. Am J Transplant. 2003;3(8):994-998.
Pahl E, Crawford SE, Wax DF, et al. Safety and efficacy of pravastatin in pediatric heart transplant recipients. J Heart Lung Transplant. 2001;20(2):230.
Wagner SJ, Turek JW, Maldonado J, et al. Less is more in post pediatric heart transplant care. Ann Thorac Surg. 2019;107(1):165-171.
Mahle WT, Vincent RN, Berg AM, et al. Pravastatin therapy is associated with reduction in coronary allograft vasculopathy in pediatric heart transplantation. J Heart Lung Transplant. 2005;24(1):63-66.
Godown J, Donohue JE, Yu S, et al. Differential effect of body mass index on pediatric heart transplant outcomes based on diagnosis. Pediatr Transplant. 2014;18(7):771-776.
Kaufman BD, Nagle ML, Levine SR, et al. Too fat or too thin? Body habitus assessment in children listed for heart transplant and impact on outcome. J Heart Lung Transplant. 2008;27(5):508-513.
Barbiero SM, D'Azevedo Sica C, Schuh DS, et al. Overweight and obesity in children with congenital heart disease: combination of risks for the future? BMC Pediatr. 2014;14:271.
Ghaderian M, Emami-Moghadam AR, Ali Samir M, et al. Lipid and glucose serum levels in children with congenital heart disease. J Tehran Heart Cent. 2014;9(1):20-26.
Daly KP, Chakravarti SB, Tresler M, et al. Sudden death after pediatric heart transplantation: analysis of data from the Pediatric Heart Transplant Study Group. J Heart Lung Transplant. 2011;30(12):1395-1402.
Kleinmahon JA, Gralla J, Kirk R, et al. Cardiac allograft vasculopathy and graft failure in pediatric heart transplant recipients after rejection with severe hemodynamic compromise. J Heart Lung Transplant. 2019;38(3):277-284.
Pamboukian SV, Costanzo MR, Meyer P, et al. Influence of race in heart failure and cardiac transplantation: mortality differences are eliminated by specialized, comprehensive care. J Card Fail. 2003;9(2):80-86.