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. 2025 Feb;29(1):e70005.
doi: 10.1111/petr.70005.

Rapid Weight Gain After Pediatric Kidney Transplant and Development of Cardiometabolic Risk Factors Among Children Enrolled in the North American Pediatric Renal Trials and Collaborative Studies Cohort

Sarah Twichell  1 , Elizabeth A K Hunt  1 , Rodica Ciurea  2 , Michael J G Somers  3   4 ; NAPRTCS investigators
Affiliations

Rapid Weight Gain After Pediatric Kidney Transplant and Development of Cardiometabolic Risk Factors Among Children Enrolled in the North American Pediatric Renal Trials and Collaborative Studies Cohort

Sarah Twichell et al. Pediatr Transplant. 2025 Feb.

Abstract

Introduction: Given the risks of cardiovascular disease among pediatric kidney transplant recipients, we evaluated whether there was an association between rapid weight gain (RWG) following kidney transplantation and the development of obesity and hypertension among children enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry.

Methods: This retrospective analysis of the NAPRTCS transplant cohort assessed for RWG in the first year post-transplant and evaluated for obesity and hypertension in children with and without RWG up to 5 years post-transplant. We evaluated three separate eras (1986-1999, 2000-2009, and 2010-2021). We performed chi-square and logistic regression analyses to assess cardiometabolic risk at three time points (1, 3, and 5 years post-transplant).

Results: The percent of children with RWG decreased across the three eras (1986-1999 37.3%, 2000-2009 23.0%, and 2010-2021 16.4%). Obesity was significantly more common among children with a history of RWG following transplant, with 48%-67% with RWG having obesity 5 years following transplant compared with 22%-25% without RWG. Hypertension was significantly more common in the RWG group than the non-RWG group at all but two time points. In logistic regression models, the odds of obesity in the RWG group compared with non-RWG was 2.55 (2.29-2.83), and the odds of hypertension were 1.00 (0.94-1.08). Steroid minimization protocols were associated with significantly less RWG.

Conclusions: RWG was significantly associated with obesity but not hypertension among pediatric kidney transplant recipients enrolled in NAPRTCS. Interventions targeting RWG following kidney transplant should be evaluated as a potential way to modify obesity rates following transplantation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Percent of children enrolled in NAPRTCS with obesity up to 5 years post transplant (panel a) and percent of children enrolled in NAPRTCS with obesity in the rapid weight gain and non‐rapid weight gain groups up to 5 years post transplant (panel b).
FIGURE 2
FIGURE 2
Percent of children enrolled in NAPRTCS with hypertension up to 5 years post transplant (panel a) and percent of children enrolled in NAPRTCS with hypertension in the rapid weight gain and non‐rapid weight gain groups up to 5 years post transplant (panel b).
FIGURE 3
FIGURE 3
Percent of individuals in the RWG and non‐RWG groups with obesity, hypertension, and both obesity and hypertension 1, 3, and 5 years post transplant across 3 eras. Percent of participants in the rapid weight gain and non‐rapid weight gain groups with (a) Obesity, (b) Hypertension and (c) Obesity and hypertension. Percentages shown 1, 3, and 5 years post transplant across 3 eras. *represents p < 0.05.
See this image and copyright information in PMC

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