Incidence of cardiovascular disease and mortality in childhood solid organ transplant recipients: a population-based study

Sandeep Brar^{1

2}, Stephanie N Dixon^{3

4

5}, J Michael Paterson^{6

7}, Jade Dirk^{3

4}, Emma Hahn^{3

4}, S Joseph Kim^{3

7

8

9}, Vicky Ng^{9

10}, Melinda Solomon^{9

11}, Jovanka Vasilevska-Ristovska¹², Tonny Banh¹², Paul C Nathan^{6

9

13}, Rulan S Parekh^{14

15

16

17}, Rahul Chanchlani^{18

19}

Affiliations

¹ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
² Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
³ ICES Western, London, ON, Canada.
⁴ Lawson Health Research Institute, London, ON, Canada.
⁵ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
⁶ ICES Central, Toronto, ON, Canada.
⁷ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁸ Division of Nephrology and the Ajmera Transplant Centre, University Health Network, Toronto, Canada.
⁹ Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹¹ Division of Respiratory Medicine, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹² Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
¹³ Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
¹⁴ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. rulan.parekh@wchospital.ca.
¹⁵ Faculty of Medicine, University of Toronto, Toronto, ON, Canada. rulan.parekh@wchospital.ca.
¹⁶ Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. rulan.parekh@wchospital.ca.
¹⁷ Academics, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada. rulan.parekh@wchospital.ca.
¹⁸ Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada.
¹⁹ Division of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

PMID: 35849223
DOI: 10.1007/s00467-022-05635-w

Incidence of cardiovascular disease and mortality in childhood solid organ transplant recipients: a population-based study

Sandeep Brar et al. Pediatr Nephrol. 2023 Mar.

. 2023 Mar;38(3):801-810.

doi: 10.1007/s00467-022-05635-w. Epub 2022 Jul 18.

Authors

Affiliations

¹ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
² Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
³ ICES Western, London, ON, Canada.
⁴ Lawson Health Research Institute, London, ON, Canada.
⁵ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
⁶ ICES Central, Toronto, ON, Canada.
⁷ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁸ Division of Nephrology and the Ajmera Transplant Centre, University Health Network, Toronto, Canada.
⁹ Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹¹ Division of Respiratory Medicine, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹² Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
¹³ Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
¹⁴ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. rulan.parekh@wchospital.ca.
¹⁵ Faculty of Medicine, University of Toronto, Toronto, ON, Canada. rulan.parekh@wchospital.ca.
¹⁶ Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. rulan.parekh@wchospital.ca.
¹⁷ Academics, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada. rulan.parekh@wchospital.ca.
¹⁸ Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada.
¹⁹ Division of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

PMID: 35849223
DOI: 10.1007/s00467-022-05635-w

Abstract

Background: With improved survival among children after transplantation, our understanding of the risk for developing other comorbidities is improving, yet little is known about the long-term risk of cardiovascular events and mortality after solid organ transplantation.

Methods: In a cohort study using health administrative data, we compared cardiovascular events in children (n = 615) with liver, lung, kidney, small bowel, or multi-organ transplant at the Hospital for Sick Children, Toronto, Canada, with asthmatic children (n = 481,697) between 1996 and 2014. Outcomes included non-fatal cardiovascular events, cardiovascular death, all-cause mortality, and a composite of non-fatal and fatal cardiovascular events. Time-stratified Cox proportional hazards models were used.

Results: Among 615 children, 317 (52%) were recipients of kidneys, 253 (41%) of livers, and the remaining 45 (7%) had lung, small bowel, or multi-organ transplants. Median follow-up was 12.1 [7.2, 16.7] years. Non-fatal incident cardiovascular events were 34 times higher among solid organ transplant recipients than non-transplanted children (incidence rate ratio (IRR) 34.4, 95% CI: 25.5, 46.4). Among transplant recipients, the cumulative incidence of non-fatal and fatal cardiovascular events was 2.3% and 13.0%, 5 and 15 years after transplantation, respectively.

Conclusions: Increased rate of cardiovascular events in children after transplantation highlights the need for surveillance during transition into adulthood and beyond. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Cardiovascular disease; Children; Health administrative databases; Mortality; Solid organ transplant.

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References

1. (2012) OPTN / SRTR 2011 Annual Data Report. HHS/HRSA/HSB/DOT
1. Meier-Kriesche HU, Schold JD, Srinivas TR, Reed A, Kaplan B (2004) Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease. Am J Transplant 4:1662–1668 - DOI
1. Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK (2000) Long-term survival in renal transplant recipients with graft function. Kidney Int 57:307–313 - DOI
1. Kasiske BL (2001) Epidemiology of cardiovascular disease after renal transplantation. Transplantation 72:S5-8 - DOI
1. Hernández-Infante E, García-Martínez C, Beltrán-de-la-Luz S, Reyes-Acevedo R, Romo-Franco L, Delgadillo-Castañeda R, Orozco-Loza I, Chew-Wong A (2010) Prevalence of posttransplant hypertension in pediatric kidney transplant recipients: effect on long term allograft survival. Rev Invest Clin 62:398–405

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Incidence of cardiovascular disease and mortality in childhood solid organ transplant recipients: a population-based study

Affiliations

Incidence of cardiovascular disease and mortality in childhood solid organ transplant recipients: a population-based study

Authors

Affiliations

Abstract

References

Publication types

MeSH terms