Abstract: TH-PO140
Incidence of Cardiovascular Diseases in Pediatric Solid Organ Transplant Recipients
Session Information
- Transplantation: Cardiovascular and Metabolic Diseases
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Brar, Sandeep, University of Toronto, Toronto, Ontario, Canada
- Dixon, Stephanie, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
- Paterson, John Michael, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
- Kim, Joseph, University of Toronto, Toronto, Ontario, Canada
- Hebert, Diane, University of Toronto, Toronto, Ontario, Canada
- Dirk, Jade S., Institute for Clinical Evaluative Sciences, London, Ontario, Canada
- Hahn, Emma J., Institute of Clinical Evaluative Sciences, London, Ontario, Canada
- Parekh, Rulan S., The Hospital For Sick Children, Toronto, Ontario, Canada
- Chanchlani, Rahul, McMaster Children’s Hospital, Hamilton, Ontario, Canada
Background
Cardiovascular disease (CVD) is a long-term complication in pediatric solid organ transplant (SOT) recipients; however, the incidence is not well described.
Methods
We conducted a cohort study comparing CVD rates in children with SOT (heart, liver, lung, kidney, small bowel) at the Hospital for Sick Children in Toronto, Canada (n = 979) with a random sample of healthy, non-transplanted children in Ontario (n = 1,000,000) between 1993 and 2014 using provincial health administrative data. Outcomes included non-fatal CVD events, CVD-specific death, and a composite of non-fatal and fatal CVD events. Non-fatal CVD events were defined as atherosclerotic (acute myocardial infarction, stroke, peripheral vascular disease, carotid endarterectomy, percutaneous coronary intervention, coronary artery bypass grafting) and non-atherosclerotic (congestive heart failure, arrhythmia, cardiac defibrillation, insertion of pacemaker, out of hospital cardiac arrest).
Results
Among SOT recipients, 41% had a kidney transplant, 32% had a liver transplant and 22% had a cardiac transplant. The remaining 5% had lung, small bowel or multi-organ transplants. Mean age at index was 7.7 and 8.1 years in the transplant and non-transplant group, respectively. During an overall median follow-up time of 11.0 years (interquartile range: 5.7-17.5 years), CVD events were at least 50 times more likely to occur in SOT recipients versus healthy, non-transplanted children (table).
Conclusion
The increased incidence of CVD in children post transplantation highlights the need for surveillance and prevention during transition into early adulthood.
Events and incidence rate ratios for cardiovascular outcomes in pediatric solid organ transplant recipients
| Outcome | Number of events | Event rate per 1000 person-years | Incidence rate ratio (per 1000 person-years) (95% CI) |
| Non-fatal composite | |||
| Non-transplant | 5727 | 0.5 | Reference |
| Transplant | 260 | 32.5 | 68.2 (60.2, 77.2) |
| Non-fatal, atherosclerotic CVD | |||
| Non-transplant | 3104 | 0.3 | Reference |
| Transplant | 167 | 19.5 | 75.7 (64.8, 88.4) |
| Non-fatal, non-atherosclerotic CVD | |||
| Non-transplant | 4422 | 0.4 | Reference |
| Transplant | 167 | 19.5 | 52.9 (45.5, 61.5) |
| CVD-specific death | |||
| Non-transplant | 633 | 0.1 | Reference |
| Transplant | 76 | 9.5 | 180.3 (142.1, 228.7) |
| Non-fatal and fatal composite | |||
| Non-transplant | 6072 | 0.5 | Reference |
| Transplant | 278 | 34.7 | 68.8 (61.0, 77.5) |