Weight Gain Trajectory Predicts Long‐term Overweight and Obesity After Pediatric Liver Transplant

Objective: The aim of the study is to identify early predictors of long‐term overweight and obesity in pediatric liver transplant recipients. Methods: Single‐center, retrospective review of children who underwent liver transplant before age 6 years. Body mass index (BMI), weight, and height percentiles at transplant and post‐transplant were calculated. BMI, weight gain trajectories, and failure‐to‐thrive (FTT) were examined as predictors of overweight/obesity at 3 and 5 years post‐transplant. Results: Children (n = 70) were median 0.9 years at transplant. Median BMI percentile increased from 37 (interquartile range (IQR) 12–73) at transplant to 83 (IQR 64–97) at 12 months, with median weight percentile 47 (IQR 26–67) and height percentile 9 (IQR 2–32). Overweight/obesity prevalence peaked at 3 years post‐transplant (44%). Children who were overweight/obese at 3 years post‐transplant were more likely to be overweight/obese at transplant, and at 6 and 12 months post‐transplant (odds ratio (OR): 9.4, P = 0.02; OR: 6.7, P = 0.013, OR: 6.4, P = 0.007, respectively). The prevalence of overweight/obesity decreased to 26% at 5 years. Rapid weight gain post‐transplant did not predict overweight/obesity at 3 or 5 years. Over one‐third of children who were FTT at transplant were overweight/obese at 3 or 5 years, but FTT at transplant did not increase later obesity risk. Conclusions: Most children gain weight rapidly after liver transplant. Nearly half of transplant recipients are overweight/obese at 3 years, but the prevalence decreases by 5 years. Those who become overweight/obese tend to do so within 1 year post‐transplant, making this an important time to identify high‐risk children and provide counseling.