420.3 Longitudinal Assessment of Subclinical Cardiovascular Target Organ Damage after Pediatric Liver Transplantation
Tuesday May 07, 2019 from 13:45 to 15:00
Bayshore D/E/F
Award Winner
Nima Memaran, Germany has been granted the IPTA Scientific Award
Presenter

Nima Memaran, Germany

Fellow

Department of Pediatric Liver, Kidney and Metabolic Diseases

Hannover Medical School

Abstract

Longitudinal Assessment of Subclinical Cardiovascular Target Organ Damage after Pediatric Liver Transplantation

Nima Memaran1, Imeke Goldschmidt1, Bianca Borchert-Mörlins1, Rizky I. Sugianto1, Hannes Wilke1, Ricarda Blöte1, Elena Bauer1, Anika von Wick1, Norman Junge1, Christoph Leiskau1, Nicolas Richter3, Eva Doreen Pfister1, Ulrich Baumann1, Bernhard M.W. Schmidt2, Anette Melk1.

1Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany; 2Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany; 3Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany

Introduction: Cardiovascular (CV) events account for 8-13% of deaths after liver transplantation (LT) in adulthood. While CV risk factors are present in children after LT, little is known about the prevalence of subclinical CV target organ damage.

Methods: We annually assessed subclinical CV damage by measuring intima-media thickness (IMT, a marker for atherosclerosis), pulse-wave velocity (PWV, signifying arteriosclerosis), and the left-ventricular mass index (LVMI, as parameter for left-ventricular hypertrophy) in 110 pediatric LT recipients (aged 11.4 ± 3.7 years) over a period of 4.6 years in a prospective longitudinal observational study to date (n=83 for F/U1, N=62 for F/U2, n=35 for F/U3, n=15 for F/U4).

Results: At inclusion, elevated IMT was present in 59%, elevated PWV in 24%, and left-ventricular hypertrophy in 10%. Mixed linear modeling including all observations identified younger age at LT, shorter time since LT, decreased renal function, and low vitamin D levels to be independently associated with higher IMT values. Microalbuminuria (detected by ACR), higher systolic blood pressure and the presence of microinflammation were associated with higher PWV. Older Age at LT, longer time since LT and less physical activity were independent predictors of higher LVMI.

Conclusion: Pediatric LT recipients display relevant subclinical CV target organ damage. Apart from immutable factors, we identified modifiable risk factors (such as blood pressure, renal damage, hypovitaminosis D) contributing to CV damage that could serve as targets for preventive measures. In light of excellent long-term survival, CV morbidity needs to be addressed in these patients.


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