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Greater Susceptibility for Metabolic Syndrome in Pediatric Solid Organ and Stem Cell Transplant Recipients

Blöte, Ricarda*,1; Memaran, Nima MD*,1; Borchert-Mörlins, Bianca MD1; Thurn-Valsassina, Daniela MD1; Goldschmidt, Imeke MD1; Beier, Rita MD2; Sauer, Martin MD3; Müller, Carsten MD4; Sarganas, Giselle MD PhD MScIH5; Oh, Jun MD6; Büscher, Rainer MD7; Kemper, Markus J. MD8; Sugianto, Rizky I. DDS MPH1; Epping, Jelena BSc9; Schmidt, Bernhard M.W. MD MSc10; Melk, Anette MD PhD1

doi: 10.1097/TP.0000000000002675
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Background: Cardiovascular (CV) comorbidity is of increasing importance after transplantation (Tx). Metabolic syndrome (MS) contributes to the risk for CV sequelae. Our aim was to assess the risk for MS in pediatric solid organ and stem cell transplant recipients by comparing them to matched untransplanted peers in a multicenter study.

Methods: We prospectively assessed MS in 295 pediatric transplant recipients and compared them to 1.475 age- and sex-matched controls.

Results: Post transplant metabolic syndrome (PTMS) was most frequent in lung (43%) and kidney (39%), followed by liver (16%) and stem cell (13%) recipients compared to non transplanted peers (4%; p<0.01). The risk of displaying PTMS was almost 22-fold higher after lung (95%CI 8.2-57.4), 16-fold higher after kidney (95%CI 9.1-28.9), 5-fold higher after liver (95%CI 2.1-10.1) and 4-fold higher after stem cell (95%CI 1.4-9.5) Tx. The contribution of individual components leading to MS differed depending on transplant type. In the combined analysis of all transplant groups older age, less physical activity, calcineurin- or mammalian target of rapamycin inhibitor based immunosuppression, and hypovitaminosis D were associated with PTMS.

Conclusions: By investigating a large group of patients, our study not only shows a high prevalence of PTMS, but also identifies kidney and lung transplant patients as being at a particularly high risk. Moreover, knowledge on the factors associated with PTMS allows for individualized treatment approaches as well as potential preventive measures.

1Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hanover, Germany

2Department of Pediatric Hematology and Oncology, Clinic for Pediatrics III, University Hospital Essen, Essen, Germany

3Department of Pediatric Hematology and Oncology, Hannover Medical School, Hanover, Germany

4Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hanover, Germany

5Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany

6Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

7Department of Pediatric Nephrology, University Hospital, Essen, Germany

8Department of Pediatrics, AK Hamburg Nord, Asklepios Medical School, Hamburg, Germany

9Department of Medical Sociology, Hannover Medical School, Hanover, Germany

10Department of Nephrology, Hannover Medical School, Hanover, Germany.

* Authors contributed equally.

Disclosure: The authors declare no conflicts of interest.

Funding: German Ministry of Education and Research (reference numbers 01EO0802 and 01EO1302); Roche Organ Transplantation Research Foundation. R.Bl. received additional support through the KlinStrucMed program at Hannover Medical School, funded by Else-Kröner-Fresenius foundation.

Corresponding author: Anette Melk, MD PhD, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Email: melk.anette@mh-hannover.de, Telephone: +49 (0)511 532 5597; Fax: +49 (0)511 532 16 5597

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