title: Posttransplant metabolic syndrome in the withdrawal of immunosuppression in Pediatric Liver Transplant Recipients (WISP-R) pilot trial.
abstract: 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.
authors: Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA.
authors: E R
authors: ER
authors: Perito
authors: S
authors: S
authors: Mohammad
authors: P
authors: P
authors: Rosenthal
authors: E M
authors: EM
authors: Alonso
authors: U D
authors: UD
authors: Ekong
authors: S J
authors: SJ
authors: Lobritto
authors: S
authors: S
authors: Feng
mesh_terms: D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016031:Liver Transplantation / Q000009:adverse effects*; D024821:Metabolic Syndrome / Q000209:etiology*; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents
keywords: Clinical research; hepatology, pediatrics; liver transplantation; metabolic syndrome, obesity, immunosuppressive regimens, minimization; practice; withdrawal
references: J Pediatr. 2008 Feb;152(2):165-70
references: 18206683
references: Curr Opin Organ Transplant. 2008 Oct;13(5):506-12
references: 19060534
references: J Am Soc Nephrol. 2009 Mar;20(3):629-37
references: 19158356
references: Arch Pediatr Adolesc Med. 2009 Apr;163(4):371-7
references: 19349567
references: Clin Transplant. 2009 Jun-Jul;23(3):329-36
references: 19210687
references: Circulation. 2009 Oct 20;120(16):1640-5
references: 19805654
references: MMWR Morb Mortal Wkly Rep. 2010 Jan 22;59(2):29-33
references: 20094024
references: Am J Gastroenterol. 2010 Mar;105(3):613-20
references: 20040915
references: Liver Transpl. 2011 Jan;17(1):15-22
references: 21254340
references: Liver Transpl. 2011 Nov;17 Suppl 3:S38-42
references: 21761552
references: Pediatrics. 2011 Dec;128 Suppl 5:S213-56
references: 22084329
references: Diabetes Care. 2012 Jan;35 Suppl 1:S64-71
references: 22187472
references: Pediatr Transplant. 2012 Feb;16(1):41-9
references: 22093689
references: JAMA. 2012 Jan 18;307(3):283-93
references: 22253395
references: JAMA. 2012 Feb 1;307(5):483-90
references: 22253364
references: Cochrane Database Syst Rev. 2012;(3):CD008852
references: 22419339
references: J Nephrol. 2012 May-Jun;25(3):269-75
references: 22573529
references: Liver Transpl. 2012 Sep;18(9):1009-28
references: 22641460
references: Vital Health Stat 11. 2002 May;(246):1-190
references: 12043359
references: Hepatology. 2013 Nov;58(5):1824-35
references: 23532679
references: Pediatrics. 2004 Aug;114(2 Suppl 4th Report):555-76
references: 15286277
references: Nephrol Dial Transplant. 2004 Dec;19 Suppl 6:vi8-vi12
references: 15575024
references: Arch Pediatr Adolesc Med. 2006 May;160(5):523-8
references: 16651496
references: Liver Transpl. 2007 Jan;13(1):46-54
references: 17154392
references: Pediatrics. 2004 Mar;113(3 Pt 1):475-82
references: 14993537
references: Pediatr Transplant. 2013 Aug;17(5):412-22
references: 23718800
references: Transpl Immunol. 2007 Feb;17(2):114-9
references: 17306742
references: J Pediatr. 2007 Jun;150(6):640-4, 644.e1
references: 17517252
references: Pediatrics. 2007 Dec;120 Suppl 4:S164-92
references: 18055651