title: Subclinical cardiovascular changes in pediatric solid organ transplant recipients: A systematic review and meta-analysis.
abstract: CV disease is a major cause of morbidity and mortality following solid organ transplantation in adults. While the prevalence of multiple cardiometabolic risk factors is increased in pediatric solid organ transplant recipients, it is not clear whether they have subclinical CV changes. cIMT, central pWV, and CAC are indicative of subclinical CV disease, and, in adults, predict future CV events. The objective of this systematic review and meta-analysis was to investigate the prevalence of subclinical CV changes, as measured by cIMT, pWV, and CAC among pediatric solid organ transplant recipients. We searched MEDLINE(®) and EMBASE and conducted meta-analysis for studies that evaluated cIMT, central pWV, and CAC among pediatric solid organ transplant recipients (kidney, lung, intestine and liver). The search identified nine eligible studies that included a total of 259 patients and 685 healthy controls. Eight studies reported on kidney transplant recipients and one study on a combined cohort of kidney and liver transplant recipients. The mean cIMT of transplant recipients was significantly higher than that of healthy controls (mean difference = 0.05 mm, 95% CI 0.02-0.07; p < 0.0001) with an estimated pooled prevalence of elevated cIMT of 56.0% (95% CI 17.0-95.0). The one study that assessed pWV showed increased vascular stiffness in transplant recipients compared to healthy controls. No studies assessing for CAC were found. There were limited data regarding subclinical CV disease following pediatric solid organ transplantation. In conclusion, kidney transplantation in childhood is associated with a higher prevalence of subclinical CV changes compared to healthy children. Longitudinal studies are needed to determine whether children have increased CV morbidity and mortality after transplantation.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Al Nasser
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Marta C
authors.initials: MC
authors.lastname: Moura
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, ON, Canada.|Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Mertens
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, ON, Canada.|Division of Cardiology, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, ON, Canada.|Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada.|SickKids Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.|SickKids Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Vicky L
authors.initials: VL
authors.lastname: Ng
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Church
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Marialena
authors.initials: M
authors.lastname: Mouzaki
mesh_terms: D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D002648:Child; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D063177:Pulse Wave Analysis
keywords: cardiac transplantation; children; complications of liver transplantation; kidney transplantation; liver transplantation