Posttransplant metabolic syndrome in the Withdrawal of Immunosuppression in Pediatric Liver Transplant Recipients (WISP-R) pilot trial

E. R. Perito, Saeed Mohammad, P. Rosenthal, Estella M Alonso, U. D. Ekong, S. J. Lobritto, Sandy Feng*

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)779-785
Number of pages7
JournalAmerican Journal of Transplantation
Volume15
Issue number3
DOIs
StatePublished - Jan 1 2015

Keywords

  • Clinical research
  • hepatology, pediatrics
  • liver transplantation
  • metabolic syndrome, obesity, immunosuppressive regimens, minimization
  • practice
  • withdrawal

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Fingerprint Dive into the research topics of 'Posttransplant metabolic syndrome in the Withdrawal of Immunosuppression in Pediatric Liver Transplant Recipients (WISP-R) pilot trial'. Together they form a unique fingerprint.

  • Cite this