Subclinical cardiovascular changes in pediatric solid organ transplant recipients: A systematic review and meta-analysis
Yasser Al Nasser
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorMarta C. Moura
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorLuc Mertens
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorBrian W. McCrindle
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorRulan S. Parekh
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada
SickKids Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorVicky L. Ng
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
SickKids Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorPeter C. Church
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Equally contributing co-senior authors.
Search for more papers by this authorCorresponding Author
Marialena Mouzaki
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Equally contributing co-senior authors.
Marialena Mouzaki, Division of Gastroenterology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, ON, Canada M5G 1X8
Tel.: 1-416-813-6170
Fax: 1-416-813-4972
E-mail: [email protected]
Search for more papers by this authorYasser Al Nasser
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorMarta C. Moura
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorLuc Mertens
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorBrian W. McCrindle
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorRulan S. Parekh
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada
SickKids Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorVicky L. Ng
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
SickKids Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorPeter C. Church
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Equally contributing co-senior authors.
Search for more papers by this authorCorresponding Author
Marialena Mouzaki
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
Equally contributing co-senior authors.
Marialena Mouzaki, Division of Gastroenterology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, ON, Canada M5G 1X8
Tel.: 1-416-813-6170
Fax: 1-416-813-4972
E-mail: [email protected]
Search for more papers by this authorAbstract
CV disease is a major cause of morbidity and mortality following solid organ transplantation in adults. While the prevalence of multiple cardiometabolic risk factors is increased in pediatric solid organ transplant recipients, it is not clear whether they have subclinical CV changes. cIMT, central pWV, and CAC are indicative of subclinical CV disease, and, in adults, predict future CV events. The objective of this systematic review and meta-analysis was to investigate the prevalence of subclinical CV changes, as measured by cIMT, pWV, and CAC among pediatric solid organ transplant recipients. We searched MEDLINE® and EMBASE and conducted meta-analysis for studies that evaluated cIMT, central pWV, and CAC among pediatric solid organ transplant recipients (kidney, lung, intestine and liver). The search identified nine eligible studies that included a total of 259 patients and 685 healthy controls. Eight studies reported on kidney transplant recipients and one study on a combined cohort of kidney and liver transplant recipients. The mean cIMT of transplant recipients was significantly higher than that of healthy controls (mean difference = 0.05 mm, 95% CI 0.02–0.07; p < 0.0001) with an estimated pooled prevalence of elevated cIMT of 56.0% (95% CI 17.0–95.0). The one study that assessed pWV showed increased vascular stiffness in transplant recipients compared to healthy controls. No studies assessing for CAC were found. There were limited data regarding subclinical CV disease following pediatric solid organ transplantation. In conclusion, kidney transplantation in childhood is associated with a higher prevalence of subclinical CV changes compared to healthy children. Longitudinal studies are needed to determine whether children have increased CV morbidity and mortality after transplantation.
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