Background: Improved patient and graft survival post-liver transplantation has led to a parallel increase in metabolic syndrome (MS) reported in multiple centres. We aimed to study the prevalence and risk factors of metabolic complications in our paediatric liver transplant (LT) cohort.
Methods: This was a retrospective review of the LT database from 1995-2018. We studied the incidence of overweight, obesity (WHO BMI criteria), dyslipidaemia, hypertension and new onset diabetes after transplantation (NODAT) at 1 and 10 years post-LT. Age at LT, indication for LT, use of steroids, including pulsed steroid therapy for graft rejection and calcineurin inhibitors (CNIs) were recorded.
Results: There were 99 post-LT patients during this period, 43 were followed up to 10-years post-LT. Median (IQR) age at LT was 2.0 (1.3-4.7) years. The incidence of overweight and obesity at 1 and 10 years was 14.1% and 9.3% respectively. The most common metabolic complication was dyslipidaemia, affecting 20.0% and 9.3% of patients at 1 and 10 years post-LT; hypertension was found in 10.1% of patients 1 year post-LT and 4.7% of patients at 10-year follow up. The incidence of NODAT at 1 and 10 years post-LT were 2.0% and 4.7% respectively. The highest incidence of metabolic derangement was at 1 year post-LT; 34.3% patients had at least 1 metabolic complication, 10.1% had 2 or more, and 2.0% met criteria for metabolic syndrome. None of our patients fulfilled criteria for MS 10 years post-LT. The use of pulsed steroid therapy for acute graft rejection was significantly associated with dyslipidaemia (P=0.006) and hypertension (P=0.05) 1 year post-LT, as well as the development of NODAT (P=0.001). Median age at LT was significantly higher in those with NODAT (14 years) versus those without (2 years) (P=0.001).
Conclusion: Metabolic derangements are common in children in the first year post-LT, but appear to be less prevalent subsequently. Pulsed steroid therapy and older age at transplant (adolescents) are potential risk factors. The incidence of metabolic complications in our cohort is lower than that described in other centres. This could be in part related to the steroid weaning protocol and lower immunosuppression targets, which has seen lower metabolic complications without a corresponding increase in graft rejection rates. Nonetheless, post-LT patients are at risk of metabolic complications compared to the general paediatric population and would need longitudinal follow up for early detection and management of these complications.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology