Obesity and dyslipidemia predict cardiac allograft vasculopathy and graft loss in children and adolescents post-heart transplant: A PHTS multi-institutional analysis
Data from this manuscript were presented at the International Society for Heart and Lung Transplantation 2020 Annual Meetings and Scientific Sessions.
Funding information
The work was supported by Enduring Hearts—PHTS Investigator Award
Abstract
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.
CONFLICT OF INTEREST
The authors have no disclosures.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from Pediatric Heart Transplant Society. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from Dr. Carmel Bogle with the permission of Pediatric Heart Transplant Society.
