ESPE Yearbook of Paediatric Endocrinology

Transplantation. 2020; 104: 1644–1653. https://pubmed.ncbi.nlm.nih.gov/32732843/

This retrospective study analyzed the incidence and risk factors for obesity in a large (n=410), single center cohort of pediatric solid-organ transplant recipients, who received their first transplant between January 1, 2002 and December 31, 2011 (median transplant age 8.9 years; median follow-up time 3.6 years). Within 5-years post-transplant, 1:4 developed obesity with higher risk in those: overweight at transplant, age < 5 at transplant, kidney transplant recipients, and higher cumulative prednisone exposure.

With the progressive improvement of survival of patients with childhood cancer, the burden of long-term comorbidities is increasingly underlined. Obesity is an increasing healthcare problem with clear cardiovascular consequences (1). In cross-sectional analyses of pediatric transplant recipients, obesity prevalence ranges from 13 to 34% and it is associated with a worse graft survival and function (2).

The study stratified the risk of obesity in a heterogeneous population, identifying specific organ groups in which further examination of organ-specific risk factors may be warranted. Across all organ groups, those who developed obesity did so within the first year post-transplant, emphasizing the need to carefully screen for obesity early after transplantation. Corticosteroid reduction and avoidance protocols for patients receiving solid organ transplant have been developed in recent years to minimize the risk of obesity and metabolic syndrome (3). The increased prevalence in kidney recipients is ascribed to the absence in these patients of the severe wasting and cachexia, which is generally associated with chronic lung, liver and heart disease.

Limitations of this study are its retrospective design and the absence of data on physical activity and nutrition. Abdominal distribution of adiposity, an essential feature of metabolic syndrome, and other metabolic syndrome components were not evaluated. Abdominal adiposity, usually assessed by weight-to-height ratio, is common in cancer survivors, while BMI underestimates obesity in these patients. A major strength of this study is the large sample size, with data collected in a universal healthcare system that captures data on all patients with healthcare and medication coverage.

Reference: 1. Jon Jin Kim, Stephen D. Marks. Long-term outcomes of children after solid organ transplantation Clinics (Sao Paulo) 2014 Jan; 69(Suppl 1): 28–38.2. Denburg MR, Pradhan M, Shults J, et al. Longitudinal relations between obesity and hypertension following pediatric renal transplantation. Pediatr Nephrol. 2010; 25: 2129–39.3. Anne Tsampalieros, et al. Corticosteroid Use and Growth After Pediatric Solid Organ Transplantation: A Systematic Review and Meta-Analysis. Transplantation. 2017 Apr; 101(4): 694–703.