Obesity and dyslipidemia predict cardiac allograft vasculopathy and graft loss in children and adolescents post-heart transplant: A PHTS multi-institutional analysis.

BACKGROUND: Obesity and dyslipidemia afflict children of all ages. We explored the prevalence of obesity and dyslipidemia in pediatric heart transplant (HT) recipients and its effects on cardiac allograft vasculopathy (CAV) and survival. METHODS: This study included primary HT recipients (≤18 years) transplanted between 01/1996 and 12/2018 included in the Pediatric Heart Transplant Society database. Obesity was categorized according to WHO/CDC guidelines and dyslipidemia according to the National Cholesterol Education Program. Kaplan-Meier analyses for CAV and graft loss stratified for BMI and lipid panels were generated and risk factors identified using multivariate analyses. RESULTS: Among 6291 HT patients (median age [range] at HT = 4.3 [0.6-12.8] years; 45% Female; 68% White), 56% had a normal BMI at HT. Obese patients at HT had an increased risk for graft loss (HR 1.19, 95% CI 1.01-1.4, p = .04). Poor total cholesterol (TC), LDL-C, and TG were associated with the risk of both CAV (HR 1.79, p < .0001; HR 1.65, p = .0015; HR 1.53, p < .0001, respectively) and graft loss (HR 1.58, p = .0008; HR 1.22, p = .04; HR 1.43, p = .0007, respectively). CONCLUSIONS: Pediatric patients who are obese at the time of HT and dyslipidemic at 1 year post-HT are at an increased risk for CAV and graft loss. Preventative interventions may reduce morbidity and mortality among this cohort.

Perceptions of solid organ transplant recipients regarding self-care management and transitioning.

Negative outcomes are consistently reported when adolescent solid organ transplant recipients are transitioned to adult transplant programs. The purpose of this quality improvement project was to understand the perceptions of patients and their parents about self-care management at transition. Solid organ transplant recipients, 16 to 22 years of age (n = 10), in a 396-bed pediatric hospital in the northeastern United States and their parents (n = 10) completed semi-structured interviews regarding health, transplant history, and participants' thoughts and feelings related to transitioning to adult transplant centers. Qualitative data were analyzed using the phenomenological method with NVIVO software to identify themes across interviews. Themes included negative perceptions of adult transplant centers due to anxiety regarding the competencies of new providers in caring for the child's medical needs, unfamiliarity with adult medical providers, fear of letting go and assuming greater responsibility, and discrepancies between providers, parents, and patients. Clinical implications are discussed, including the creation of a pediatric transition clinic and strategies for providers to promote self-care management among patients.