Premium
Posttransplant Metabolic Syndrome in the Withdrawal of Immunosuppression in Pediatric Liver Transplant Recipients (WISP‐R) Pilot Trial
Author(s) -
Perito E. R.,
Mohammad S.,
Rosenthal P.,
Alonso E. M.,
Ekong U. D.,
Lobritto S. J.,
Feng S.
Publication year - 2015
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13024
Subject(s) - medicine , immunosuppression , calcineurin , overweight , liver transplantation , metabolic syndrome , dyslipidemia , obesity , gastroenterology , transplantation
Posttransplant metabolic syndrome (PTMS)—obesity, hypertension, elevated triglycerides, low HDL and glucose intolerance—is a major contributor to morbidity after adult liver transplant. This analysis of the Withdrawal of Immunosuppression in Pediatric Liver Transplant Recipients (WISP‐R) pilot trial is the first prospective study of PTMS after pediatric liver transplant. Twenty children were enrolled in WISP‐R, at median age 8.5 years (IQR 6.4–10.8), and weaned from calcineurin‐inhibitor monotherapy. The 12 children who tolerated complete immunosuppression withdrawal were compared to matched historical controls. At baseline, 45% of WISP‐R subjects and 58% of controls had at least one component of PTMS. Calcineurin‐inhibitor withdrawal in the WISP‐R subjects did not impact the prevalence of PTMS components compared to controls. At 5 years, despite weaning off of immunosuppression, 92% of the 12 tolerant WISP‐R subjects had at least one PTMS component and 58% had at least two; 33% were overweight or obese, 50% had dyslipidemia, 33% glucose intolerance and 42% systolic hypertension. Overweight/obesity increased the risk of hypertension in all children. Compared to controls, WISP‐R tolerant subjects had similar GFR at baseline but did have higher GFR at 2, 3 and 4 years. Further study of PTMS and immunosuppression withdrawal after pediatric liver transplant is warranted.