[PP.04.01] CARDIOVASCULAR RISK FACTORS IN CHILDREN AFTER LIVER TRANSPLANTATION

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Abstract

Objective:

Adult liver transplant recipients present with increased risk of cardiovascular (CV) events, but there is no evidence in children. Diabetes, arterial hypertension, renal dysfunction and lipid disturbances may result from long-term immunosuppression. Recent advancement in biochemical methods enabled to assess the risk The aim of this study was to assess the risk of CV complications after pediatric liver transplantation (LTx).

Design and method:

We prospectively analyzed 69 patients (27 boys) at the median age of 14,3 years (range 10,2–17,8) and at least 5 years (range 5–16) after LTx. We assessed blood pressure, carotid intima-media thickness (cIMT), relative wall thickness (RWT), left ventricular mass index (LVMI), aortal pulse wave velocity (PWV), lipids including apolipoproteins (apoA1, apoB, ApoE), lipoprotein(a)-Lp(a). All values were normalized for age and expressed as SDS values. Laboratory results were compared with age-matched healthy control group, n = 60, median age 13.7 (10,4–18,0).

Results:

All patients presented with normal BP (< 95th percentile). BMI Z-score 90th percentile was exceeded in 11 patients (16%). cIMT was normal in all patients according to age percentiles, mean 0.38 ± 0.02; mean RWT was 0,32 ± 0.02, abnormal in 8 (11.5%) and LVMI-S was 28,0 ± 5.8 abnormal in 5 (7%) patients. Mean PWV was 4,75 ± 0,75 and 4 (5,7%) patients showed PWV values >95 percentile. Cholesterol 153,2 ± 37 mg/dl, triglycerides 81,7 ± 30 mg/dl, HDL 50,4 ± 12 mg/dl and LDL 85 ± 32 mg/dl were normal in the study group. Apolipoproteins differed between the study group and control: ApoE 10,3 ± 3,1 vs 16,9 ± 2,5 g/l (p < 0,01), ApoB 0,66 g/l ± 0,21 vs 0,78 ± 0,20 (p < 0.01), ApoAI 1,41 ± 0,22 vs 1,29 ± 0,30 (p < 0,01) and Lp(a) 16,0 ± 6,3 vs 12,0 ± 11,6 mg/ dl (p = 0,02).

Conclusions:

Patients after pediatric LTx present with higher risk of cardiovascular issues, however in spite of increased biochemical markers, the risk of atherosclerosis is not significant. Cardiac follow-up is mandatory, especially in adolescents before transition to adult care.

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