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Presenter: Nima, Memaran Dadgar, Hannover, Germany
Authors: Nima Memaran Dadgar, Imeke Goldschmidt, Daniela Thurn, Bianca Borchert-Mörlins, Elena Bauer, Rizky Sugianto, BernhardMW Schmidt, Ulrich Baumann, Anette Melk
Presence of early cardiovascular Disease in pediatric Patients after Liver Transplantation
Nima Memaran Dadgar1, Imeke Goldschmidt1, Daniela Thurn1, Bianca Borchert-Mörlins1, Elena Bauer1, Rizky Sugianto1, Bernhard MW Schmidt2, Ulrich Baumann1, Anette Melk1.
1Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hanover Medical School, Hanover, Germany; 2Department of Nephrology and Hypertension , Hanover Medical School, Hanover, Germany
Cardiovascular disease (CVD) causes a high degree of morbidity and mortality in adults after liver transplantation (LT). No consistent data exists on the prevalence of CV risk factors or the burden of CVD in children and adolescents after pediatric LT. Early CVD manifests as subclinical damage with elevated aortal pulse-wave velocity (PWV) indicating arteriosclerosis and increased carotid intima-media thickness (IMT) as a measure of atherosclerosis.
We assessed 51 pediatric patients (21 male) for CV risk factors (obesity, hypertension, low HDL, chronic kidney disease, CKD) and subclinical CV damage (IMT and PWV; presented as absolute and height-adjusted SDS values). Anthropometric data are given in Tab.1.
Based on casual blood pressure (BP) measurements 8/46 patients (17%) showed hypertensive BP values and/or were on antihypertensive medication. Decreased HDL levels were found in 11/31 patients (35%). Impairment in renal function was detected in 7/43 patients (16%) with 4 patients at CKD stage 2, 2 at stage 3, and 1 at stage 4. Mean PWV was 5.0±0.7 m/s, PWV-SDS 0.3±1.5 (-4.2–+3.8), reflecting 7/48 patients (15%) with PWV values above the 95th centile. Mean cIMT 0.48 ± 0.05 mm, cIMT-SDS 2.20 ± 0.95 (-0.1 - +4.81), with 36/49 patients (73%) above the 95th centile.
Whereas obesity was not common in our patient cohort, we found a considerable amount of patients to be hypertensive, displaying low HDL levels and having impaired renal function. Even though mean PWV-SDS was around the 50th centile, over a quarter of patients had PWV-values at or above the 90th centile. With regard to IMT, almost all values were above the 50th centile and almost three quarters above the 95th centile. This indicates a distinct subgroup of patients with clear pathologic alterations.
CV risk factors are common among patients after pediatric LT. Early, subclinical manifestations of CVD can be detected and are common in patients after pediatric LT. Further research into risk profiles as well as longitudinal studies on the course of CVD are warranted. CV parameters should be routinely assessed and CV risk factors diligently treated in the medical care of this patient collective.
1This work was supported by grants from the German Federal Ministry of Education and Research (ref no: 01EO1302, 01EO0802)..
 Madhwal, S., et al., Is liver transplantation a risk factor for cardiovascular disease? A meta-analysis of observational studies. Liver Transpl, 2012. 18(10): p. 1140-6
 Kracht, D., et al., Validating a new oscillometric device for aortic pulse wave velocity measurements in children and adolescents. Am J Hypertens, 2011. 24(12): p. 1294-9
 Doyon, A., et al., Carotid artery intima-media thickness and distensibility in children and adolescents: reference values and role of body dimensions. Hypertension, 2013. 62(3): p. 550-6.