Healthy Body Weights With Corticosteroid-Free Immunosuppression Is The Best Predictor of Cardiovascular Health In Children After Liver Transplantation

Introduction: Cardio-metabolic dysregulation (CMD) influences morbidity and mortality risk in adults post-liver transplantation (LTx). CMD is reported in 10–25% of pediatric LTx recipients, but no information regarding the longitudinal expression of CMD is available. The study objective was to examine the longitudinal expression of CMD and associations with body composition and growth in children post-LTx. Methods: A retrospective review was conducted in youth (34F/30 M) who underwent LTx between 1994–2015 at the Stollery Children's Hospital. Primary outcomes included; serum markers of CMD (insulin, glucose, Hemoglobin A1C [A1C], HOMA-IR [abnormal >3], lipid panel (triglycerides [TG], total cholesterol [TC], high-density-lipoprotein-cholesterol [HDL-cholesterol], low-density-lipoprotein-cholesterol [LDL-cholesterol]) and systolic/diastolic blood pressure (BP: absolute/z-scores). Results: Mean (± SD) age, weight-z, height-z, BMI-z was 9.7 ± 3.4 years (3.5–17.9), 0.26 ± 1.03, 0.017 ± 1.2, and 0.41 ± 1.05, respectively. The majority of children had %fat mass (FM), %fat-free mass (FFM) within normal reference ranges. Systolic/diastolic BP were within healthy references ranges in 83.1% and 93.5% of children, respectively. Serum insulin (83.4%) and HDL-cholesterol (43.9%) concentrations were low, with abnormal findings of other laboratory markers found in 9.7 years) and FFM (total, arms). Insulin levels decreased significantly in the first four years post-LTx, but no changes in lipid panel, A1C and glucose were noted over 10 years. Conclusions: Pediatric LTx recipients with healthy body weights and CST-free immunosuppression have a low expression of CMD over 10 years. Address correspondence and reprint requests to Dr Diana R. Mager, PhD, MSc, RD, Associate Professor, Clinical Nutrition, 2-021D Li Ka Shing Centre for Research Innovation, Clinical Research Unit, Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB, Canada, T6G 0K2 (e-mail: mager@ualberta.ca). Received 3 July, 2018 Accepted 18 December, 2018 Authors Roles and Responsibilities Diana R Mager PhD RD: Responsible for study design, data collection (AH/DRM),data analysis and intellectual/scientific interpretation, wrote manuscript, approved final manuscript. PI/corresponding author. Amber Hager, Dietetic Intern. Collected data, contributed to data analysis and intellectual/scientific interpretation, wrote manuscript, approved final manuscript. Kerry Siminoski MD FRPCP. Contributed to data collection, intellectual/scientific interpretation, approved final manuscript. Jason Yap MBBS FRACP. Responsible for study design, contributed to data interpretation/data analysis, approved final manuscript. Susan Gilmour. Responsible for study design, contributed to data interpretation/data analysis, approved final manuscript. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). The authors report no conflicts of interest. © 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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