Overweight and obesity in pediatric liver transplant recipients: prevalence and predictors before and after transplant, United Network for Organ Sharing Data, 1987-2010

Perito ER, Glidden D, Roberts JP, Rosenthal P. Overweight and obesity in pediatric liver transplant recipients: Prevalence and predictors before and after transplant, United Network for Organ Sharing Data, 1987–2010.
Pediatr Transplantation 2012: 16: 41–49. © 2011 John Wiley & Sons A/S. Abstract: Obesity is extremely common in adult liver transplant recipients and healthy U.S. children. Little is known about the prevalence or risk factors for post‐transplant obesity in pediatric liver transplant recipients. UNOS data on all U.S. liver transplants 1987–2010 in children 6 months–20 yr at transplant were analyzed. Subjects were categorized as underweight, normal weight, overweight, or obese by CDC guidelines. Predictors of weight status at and after transplant were identified using multivariate logistic regression. Of 3043 children 6–24 months at transplant, 14% were overweight. Of 4658 subjects 2–20 yr at transplant, 16% were overweight and 13% obese. Children overweight/obese at transplant were more likely to be overweight/obese at one, two, and five yr after transplant in all age groups after adjusting for age, ethnicity, primary diagnosis, year of transplant, and transplant type. Weight status at transplant was not associated with overweight/obesity by 10 yr after transplant. The prevalence of post‐transplant obesity remained high in long‐term follow‐up, from 20% to 50% depending on age and weight status at transplant. Weight status at transplant is the strongest predictor of post‐transplant overweight/obesity. To optimize long‐term outcomes in pediatric liver transplant recipients, monitoring for obesity and its comorbidities is important.     

Characteristics of diabetes after pediatric liver transplant

Greig F, Rapaport R, Klein G, Akler G, Annunziato R, Miloh T, Arnon R, Florman S, Kerkar N. Characteristics of diabetes after pediatric liver transplant. Abstract: Studies of DALT in pediatric recipients describe incidence and risk factors, but diagnostic criteria varied. This study reports characteristics and course of pediatric DALT by established diabetes criteria. Retrospective chart review of pediatric LT recipients evaluated for hyperglycemia (1/1/1997–12/30/2009) and matched, non‐diabetic controls. DALT: random blood glucose >11.1 mm , ≥2 times, with insulin treatment. DALT diagnosed in 8.0% (24/300) included 7/24 (29.2%) with severe hyperglycemia (>27.7 mm ), ketoacidosis in 2/24 (8.3%). At diagnosis, age was ≥11 yr old in 22/24 (91.7%); body mass was lean (BMIz ?0.2 ± 1.5). Mean blood glucose was 24.6 mm with negative diabetes autoantibodies (19/19) and elevated C‐peptide (2.3 nm ). DALT onset median 5.0 months included 29.1% >12 months. Insulin duration median 4.6 months included 41.7% >6 months. DALT resolved in 83.3% over 4.9 (0.9–9.1) yr. DALT differed from controls by increased preceding rejections, prednisolone dose, tacrolimus level, and triple immunosuppression (all p < 0.01). In conclusion, pediatric DALT occurred in non‐obese adolescents with insulin resistance, distinct from diabetes types 1 or 2. DALT was associated with preceding rejection and increased immunosuppression. Blood glucose monitoring, especially during increased immunosuppression following LT, could allow early diagnosis and reduce morbidity.     

Lipid profile and cardiovascular risk factors in pediatric liver transplant recipients

Cardiovascular diseases induce long‐term morbidity and mortality of adult LT recipients. The aim of this retrospective study was to assess CVRF, lipid abnormalities, and atherosclerosis (appraised by c‐IMT), more than 10 yr after pediatric LT. Thirty‐one children who underwent LT between December 1990 and December 2000 were included. Median age at LT was 14 months (range 4–64), and median follow‐up after LT was 11.9 yr (range 9.0–17.3). In our cohort, obesity (9.7%) and treated hypertension (9.7%) were rare. None of the patients was smoker or diabetic. High TC and TG were both observed in 6.5% of the patients. The mean c‐IMT for male patients was 1.22 ± 1.55 and 1.58 ± 1.23 mm in female patients. Seven patients (22%) had a mean c‐IMT above +2 s.d. Values below the 5th percentile were noted for LDL‐cholesterol (58.1%), HDL‐cholesterol (25.8%), apolipoprotein B (40%), and apolipoprotein A1 (20%). LDL‐cholesterol and apolipoprotein B levels were significantly lower in patients treated by tacrolimus in comparison with CsA (p < 0.05). In conclusion, our results suggest that pediatric LT patients do not present significant CVRF; moreover, instead of hyperlipidemia, hypocholesterolemia (LDL‐C) is frequent and immunosuppressive therapy is probably the cause.     

Single‐center assessment of nutritional counseling in preventing excessive weight gain in pediatric renal transplants recipients

Post‐transplantation obesity is a common complication that is associated with a higher risk for decreased allograft function and hypertension. However, the role of diet intervention on reducing post‐transplantation obesity is relatively unknown. We investigated the clinical relevance of dietary counseling on the prevalence of overweight/obesity during the first two yr following renal transplantation. The computerized patient records of 42 recipients (31 males) aged 6.3 ± 4.8 yr at transplantation were reviewed. All patients systematically underwent yearly dietary assessment/counseling (motivational interviewing technique) and measurement of renal function and ABPM. At transplantation, 14.2% of patients were overweight/obese, which increased to 42.8% by two yr post‐transplantation (p = 0.004). The majority of patients experienced a significant increase in BMI SDS during the first six months post‐transplantation that remained sustained throughout the duration of the follow‐up period (p = 0.001). By two yr post‐transplantation, there were no observable differences between patients classified as having normal BMI or being overweight/obese with regard to renal function and controlled hypertension. The application of yearly tailored dietary assessment/counseling had a poor effect on preventing post‐transplantation weight gain, suggesting the need for more comprehensive interventions to reduce post‐transplant obesity.     

Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology

Identification of risk factors for PRES after organ transplant can improve early detection and avoid permanent neurological injury. High calcineurin‐inhibitor levels and hypertension are recognized risk factors for PRES in adult transplant recipients. Limited data exist regarding PRES after pediatric HTx, with studies limited to case reports. We performed a retrospective review of 128 pediatric HTx recipients to identify risk factors for PRES. Seven of 128 (5.5%) recipients developed PRES at a median of 10 days (5–57) after HTx. The median age of recipients with PRES was 10.0 yr (5.7–19.0), compared to 1.4 yr (0.0–19.8) for recipients without PRES (p = 0.010). Fewer than half of recipients with PRES had elevated post‐transplant calcineurin‐inhibitor levels (n = 3) and/or preceding severe hypertension (n = 3). Four of seven who developed PRES (57%) had pretransplant Glenn or Fontan physiology (G/F). G/F was a significant risk factor for PRES (RR 4.99, 95% CI: 1.19–21.0, p = 0.036). Two recipients (29%), both with severe PRES, had residual neurological symptoms. In summary, PRES occurred in 5.5% of pediatric HTx recipients and presented early after HTx. All recipients with PRES were > 5 yr. Patients with pretransplant G/F were at increased risk, a risks factor not previously described.     

Cardiometabolic risks vary by weight status in pediatric kidney and liver transplant recipients: A cross‐sectional,single‐center study in the USA

There is an increasing need to understand long‐term metabolic changes and resultant comorbidities because life expectancy is increasing after pediatric kidney and liver transplants. We evaluated differences in classic and novel cardiometabolic biomarkers among obese and normal weight adolescent transplant recipients. We enrolled a total of 80 adolescent (mean±SD, 14.8 years ±3.0) transplant recipients (63 kidney, 17 liver) with mean duration from transplantation of 6.0 (±4.1) years. Among kidney transplant recipients, overweight and obese individuals had higher leptin (16.7 vs 7.5 μg/mL, P<.001), lower HDL (1.1 vs 1.3 mmol/L, P=.02), higher free fatty acid (0.6 vs 0.5 mmol/L, P=.03), higher apoB‐to‐apoA1 ratio (0.8 vs 0.6, P=.03), and higher glucose (5.8 vs 4.3 mmol/L, P=.03) concentrations compared to normal weight individuals. Regardless of obesity status, over half of all participants (57.5%) were considered at high cardiometabolic risk using consensus guidelines, and this was more pronounced for kidney transplant recipients (61.9%). Post‐transplantation adolescents have increased cardiometabolic risk characterized by traditional risk factors of obesity and diabetes. The presence of obesity significantly worsens biomarkers of cardiometabolic risk. Future studies should explore whether treatment of obesity can improve the health and long‐term outcomes for children undergoing solid organ transplant.     

The cardiometabolic syndrome in the adolescent

With recent increases in obesity among the pediatric age group, problems previously seen primarily in adults, such as type 2 diabetes and essential hypertension, are being more frequently diagnosed in young individuals. This has lead to interest in the development of the constellation of cardiovascular risk factors known as the cardiometabolic syndrome in the pediatric population. With these cardiovascular risk factors manifesting earlier, there is reason to be concerned that the earlier and longer exposure will result in earlier presentation of cardiovascular and microvascular events and lead to a devastating public health impact. In this review we examine the evidence for the increased prevalence of the cardiometabolic syndrome in the pediatric age group and the impact of childhood overweight on the prevalence of this syndrome in children as well as the impact on adult obesity and metabolic derangements.     

Using pediatric liver grafts (≤6 yr) for adult recipients: A considerable option?

In LT, the common policy is to allocate pediatric liver grafts to pediatric recipients. Pediatric organs are also offered to adults if there is no pediatric recipient. However, they are rarely accepted for adult recipients. So far, there is no information available reporting outcome of LT in adult recipients using pediatric livers from donors ≤6 yr. In this study, we included nine adult recipients (seven females and two males) who received grafts from children ≤6 yr from January 2008 to December 2013. We evaluated the graft quality, the GBWR and analyzed the recipients’ perioperative course. Laboratory samples and graft perfusion were analyzed. Nine adults with a median age of 49 yr (range: 25–65) and a median weight of 60 kg (range: 48–64) underwent LT with a pediatric donor graft. Median donor age was five yr (range: 3–6). Median GBWR was 1.02 (range: 0.86–1.45). After a median follow‐up of 3.9 yr (range: 11 months–6.6 yr), patient survival was 100%; graft survival was 89%. One patient needed re‐transplantation on the second postoperative day due to PNF. Eight recipients were discharged from the ICU after 2–9 days with a regular graft function. Doppler scans revealed regular flow patterns at any time. Only if denied for pediatric recipients, the use of pediatric livers from donors ≤6 yr for adult recipients is a considerable option.     

Invasive candidiasis in liver transplant patients: Incidence and risk factors in a pediatric cohort

Prolonged OR, re‐transplantation, and high‐volume intraoperative transfusion have been associated with increased risk for IC in adult LT recipients. Antifungal prophylaxis is recommended for adult patients with these risk factors. There are limited data on the incidence of and risk factors for IC in pediatric LT recipients. A retrospective cohort study of all pediatric LT patients at the CHOP between 2000 and 2012 and the CHP between 2004 and 2012 was performed to define the incidence of IC within 30 days of LT. A 3:1 matched case–control study with incidence density sampling was performed. Conditional logistic regression analyses were used to explore risk factors associated with IC. Among 397 recipients, the incidence of IC was 2.5%. Bivariate analyses showed that ICU admission prior to transplant, OR > 10 h, intraoperative volume infusion of >300 mL/kg, and broad‐spectrum antibiotics were significantly associated with IC. In a multivariate model, only ICU admission remained significantly associated with IC. Antifungal prophylaxis was not significantly protective against IC. The low incidence of IC and lack of an identified protective effect from antifungal prophylaxis suggest that prophylaxis in pediatric LT recipients should not be routinely recommended to prevent IC events in the first 30 days post‐transplant.     

Cardiovascular risk factors and cardiac disorders in long‐term survivors of pediatric liver transplantation

The MetS and cardiovascular disease are leading causes of late morbidity in adult liver transplantation recipients; however, limited data are available in pediatric liver transplantation. A single‐center retrospective review was undertaken for patients who had a liver transplantation before 18 yr of age and were >5 yr post‐transplantation, to study the prevalence of MetS, its components, and cardiac disorders. Fifty‐eight patients were included in the study with a mean age at transplantation of 6.3 ± 6.1 yr and mean follow‐up of 14.1 ± 6.0 yr. Of the study group, 41.4% were overweight or obese, with ongoing prednisone use and increased duration of follow‐up being significant risk factors. Fifty‐three patients had sufficient data for determining MetS, which was present in 17% of the patients. Although the prevalence of MetS is low in pediatric liver transplant recipients, it is associated with CKD and prednisone therapy (p < 0.05). Echocardiography data were available for 23 patients, of whom 43.4% had LVH and 13% had evidence of PH. The spectrum of cardiac disorders in this population is much wider than in adults.     

Associations of overweight with insulin resistance, beta-cell function and inflammatory markers in Chinese adolescents

Background: Obesity is a growing global health problem. Obesity‐associated inflammatory and metabolic consequences may vary in different ethnic populations, and data in Chinese adolescents are sparse. In this study, we analysed the clinical and biochemical factors associated with overweight and obesity in Chinese adolescents. Methods: This is a cross‐sectional cohort study with 2102 Chinese adolescents randomly selected from 14 secondary schools in Hong Kong. Clinical and biochemical parameters including inflammatory markers, among different groups stratified by degrees of obesity, were compared by multivariate logistic regression analysis. Results: The median age was 16 yr (interquartile range: 14–17 yr) (45.6% boys and 54.4% girls). Among the boys, 16.5% were overweight and 6.8% were obese. The respective percentages in girls were 8.2 and 5.8%. Compared with the group with normal weight in both boys and girls, high systolic blood pressure (SBP), increased insulin resistance (by homoeostasis model assessment, HOMA‐IR), elevated high‐sensitivity C‐reactive protein (hsCRP) level and low high‐density lipoprotein cholesterol (HDL‐C) level were independently associated with overweight/obesity. In boys, the respective odds ratio (95% CI) was 1.03 (1.01–1.05) for SBP, 21.0 (12.0–36.8) for HOMA‐IR, 3.65 (2.10–6.35) for hsCRP and 0.24 (0.11–0.51) for HDL‐C. In girls, the respective figures were 1.02 (1.00–1.04), 9.82 (5.65–17.1), 6.28 (3.12–12.6) and 0.18 (0.08–0.41). In girls, low‐density lipoprotein cholesterol was also independently associated with overweight/obesity [1.56 (1.09–2.24)]. Conclusions: In Chinese adolescents, overweight/obesity is independently associated with SBP, insulin resistance, hsCRP and low HDL‐C. Early intervention in overweight and obese adolescents may potentially retard the development of these cardiovascular risk factors.     

Obesity class does not further stratify outcome in overweight and obese pediatric patients after heart transplantation

The effect of obesity stratification on pediatric heart transplant outcomes is unknown. The UNOS database was queried for patients ≥2‐<18 years listed for heart transplant and stratified by BMI: normal (BMI>5%‐≤85 percentile), overweight (BMI=86%‐95 percentile), class 1 (BMI=100%‐120% of 95 percentile), class 2 (BMI=121%‐140% of 95 percentile), and class 3 obesity (BMI>140% of 95 percentile). A total of 5056 individuals were listed for transplant, with 71% normal, 13% overweight, 10% class 1, 4% class 2, and 2% class 3 obesity. Waitlist survival was not different between groups. Post‐transplant survival was decreased in overweight and combined obese groups vs normal, with no further difference between overweight and obese classes. Overweight and obese patients had higher listing status and were more likely to have ventilator, inotrope, and mechanical circulatory support at listing. After transplant, there was an association of overweight‐obese patients with diabetes and rejection requiring hospitalization. Stricter definition of normal weight reveals overweight‐obese status was an independent risk factor for poorer post‐transplant survival, without further effect by stratification of weight class. However, because there is no difference in waitlist survival, this study does not allow the selection of absolute weight‐based criteria regarding transplant listing and suggests the need to look further for modifiable risk factors post‐transplant.     

Dietary and lifestyle counselling reduces the clustering of overweight‐related cardiometabolic risk factors in adolescents

Aim: The aim of this study was to evaluate the impact of individualised dietary and lifestyle counselling, primarily aimed to decrease serum low‐density lipoprotein cholesterol, on the clustering of overweight‐related cardiometabolic risk factors in children. Design and participants: The 7‐month‐old study children were randomized either to counselling (n = 540) or control group (n = 522). Main outcome measures: The 5‐ to 15‐year‐old participants who fulfilled the international criteria were classified as overweight. Being in the highest [lowest for high‐density lipoprotein (HDL) cholesterol] age‐ and gender‐specific quintile of body mass index (BMI), blood pressure, serum triglycerides, HDL cholesterol or glucose was considered a risk factor. A cluster was defined as having high BMI and ≥2 other risk factors. Results: The counselling did not reduce the prevalence of overweight in 5‐ to 15‐year‐old participants. From age 7 onwards, the proportion of children with ≥2 risk factors was lower in the intervention than in the control group (p = 0.005). At the age of 15 years, 13.0% of girls and 10.8% of boys in the intervention group and 17.5% of girls and 18.8% of boys in the control group had the risk factor cluster (p = 0.046 for main effect of the study group). Having even one risk factor at the age of 5 years predicted the clustering of risk factors at the age of 15 years (OR: 3.8, p < 0.001). Conclusion: Repeated, individualized dietary and lifestyle counselling may reduce the clustering of overweight‐related cardiometabolic risk factors in adolescents even though the counselling is not intense enough to prevent overweight.     

Risk factors for early and late biliary complications in pediatric liver transplantation

BC are a common source of morbidity after pediatric LT. Knowledge about risk factors may help to reduce their incidence. Retrospective analysis of BC in 116 pediatric patients (123 LT) (single institution, 05/1990–12/2011, medium follow‐up 7.9 yr). One‐, five‐, and 10‐yr survival was 91.1%, no patient died of BC. Prevalence and risk factors for anastomotic and intrahepatic BC were examined. There were 29 BC in 123 LT (23.6%), with three main categories: 10 (8.1%) primary anastomotic strictures, eight (6.5%) anastomotic leaks, and three (2.4%) intrahepatic strictures. Significant risk factors for anastomotic leaks were total operation time (increase 1.26‐fold) and early HAT (<30 days post‐LT; increase 5.87‐fold). Risk factor for primary anastomotic stricture was duct‐to‐duct choledochal anastomosis (increase 5.96‐fold when compared to biliary‐enteric anastomosis). Risk factors for intrahepatic strictures were donor age >48 yr (increase 1.09‐fold) and MELD score >30 (increase 1.2‐fold). To avoid morbidity from anastomotic BC in pediatric LT, the preferred biliary anastomosis appears to be biliary‐enteric. Operation time should be kept to a minimum, and HAT must by all means be prevented. Children with a high MELD score or receiving livers from older donors are at increased risk for intrahepatic strictures.     

Metabolic syndrome in pediatric renal transplant recipients: Comparing early discontinuation of steroids vs. steroid group

Maduram A, John E, Hidalgo G, Bottke R, Fornell L, Oberholzer J, Benedetti E. Metabolic syndrome in pediatric renal transplant recipients: Comparing early discontinuation of steroids vs. steroid group. Pediatr Transplantation 2010:14:351–357. © 2009 John Wiley & Sons A/S. Abstract: Steroids have played a valuable role in transplantation as a treatment option. The purpose of this study is to assess the prevalence of MS in pediatric RT patients receiving SG or early SWG; SG discontinued five days after transplantation. We retrospectively reviewed 58 pediatric RT patients between 2000 and 2007. MS criterion was defined as the presence of any three of five criteria: (i) BMI >97th percentile, (ii) hypertension (SBP/DBP > 95th percentile or on medications); (iii) triglycerides > 95thpercentile, (iv) HDL cholesterol < 5th percentile, (v) fasting glucose > 100 mg/dL. Twenty‐five patients (43%) received SG and 33 patients (57%) received SWG. The prevalence of MS in SG was 68% compared to 15% in SWG. At six months and one yr after transplantation, mean serum glucose, total cholesterol, and triglycerides were significantly lower in the SWG. The prevalence of hypertension was significantly lower in the SWG, and patients in the SWG received significantly less lipid‐lowering and anti‐hypertensive medications than SG. Mean BMI percentile was significantly higher in SG one yr after transplantation but not after six months, although always significantly higher in patients with MS (p < 0.05). From this study, we conclude that for pediatric RT patients, cardiovascular risk factors are significantly lower in SG withdrawal groups.     

Cardiovascular risk factors in children after kidney transplantation – From short‐term to long‐term follow‐up

Cardiovascular‐related mortality is 100‐fold higher in pediatric renal transplant recipients than in the age‐matched general population. Seventy‐seven post‐renal transplant children's charts were reviewed for cardiovascular risk factors at two and six months after transplantation (short term) and at two yr after transplantation and the last follow‐up visit (mean 7.14 ± 3.5 yr) (long term). Significant reduction was seen in cardiovascular risk factors prevalence from two months after transplantation to last follow‐up respectively: Hypertension from 52.1% to 14%, hypercholesterolemia from 48.7% to 33%, hypertriglyceridemia from 50% to 12.5%, anemia from 29.6% to 18.3%, hyperparathyroidism from 32% to 18.3% and hyperglycemia from 11.7% to 10%, and left ventricular hypertrophy from 25.8% at short term to 15%. There was an increase in the prevalence of obesity from 1.5% to 3.9% and of CKD 3–5 from 4.75% to 24%. The need for antihypertensive treatment decreased from 54% to 42%, and the percentage of patients controlled by one medication rose from 26% to 34%, whereas the percentage controlled by 2, 3, and 4 medications decreased from 21.9%, 5.5%, and 1.4% to 6%, 2%, and 0. Children after renal transplantation appear to have high rates of cardiovascular risk factors, mainly on short‐term follow‐up.     

Parental functioning improves the developmental quotient of pediatric liver transplant recipients

Psychomotor development in pediatric liver transplant (LT) recipients depends on several factors. Our aim was to evaluate the importance of parental involvement and family dynamics on psychomotor development by assessing (i) children and parents individually, (ii) the parent–child relationship, and (iii) the correlation between parental functioning and patient outcome, all before and after LT. Age‐appropriate scales were used before and after LT. Twenty‐one patients, 19 mothers, and 16 fathers were evaluated. Developmental quotient (DQ): No subjects scored in the “very good” range. The proportion of children with deficits increased from LT to two yr: 17.6% vs. 28.6%. Subjects 0–2 yr were more likely to have normal DQ at transplant (66.7% vs. 50% for older children). Abnormal DQ was more prevalent two yr post‐LT in children older at LT (p = 0.02). The mother–child relationship was normal in 59% of families pre‐LT and in 67% at two yr. The relationship was more favorable when the child received a transplant as an infant (p = 0.014 at 12 months post‐LT). Normal DQ was associated with higher maternal global functioning score pre‐LT (p = 0.03). Paternal performance scores were higher than maternal scores. Children transplanted after two yr of age suffer greater long‐term deficits than those transplanted as infants.     

Late allograft fibrosis in pediatric liver transplant recipients: Assessed by histology and transient elastography

Late allograft fibrosis in LT recipients can cause graft dysfunction and may result in re‐transplantation. TE is a non‐invasive tool for the assessment of liver fibrosis. We aimed to evaluate the prevalence of allograft fibrosis in pediatric LT recipients, identify factors associated with allograft fibrosis, and determine the diagnostic value of TE, compared to histology. All children who underwent LT for ≥3 years were included. TE was performed for LSM in all patients. LSM of ≥7.5 kPa was considered as abnormal and suggestive of allograft fibrosis. Percutaneous liver biopsy was performed when patients had abnormal LSM and/or abnormal LFTs. Histological fibrosis was diagnosed when METAVIR score ≥F1 or LAF scores ≥1. TE was performed in 43 patients and 14 (32.5%) had abnormal LSM suggestive of allograft fibrosis. Histological fibrosis was identified in 10 of the 15 patients (66.7%) who underwent percutaneous liver biopsy and associated findings included chronic active HBV infection (n = 3), and late acute rejection (n = 3). Multivariate analysis showed that graft age was significantly associated with allograft fibrosis (OR = 1.22, 95% CI: 1.05‐1.41, P = 0.01). In conclusion, late allograft fibrosis is common in children undergoing LT for ≥3 years and associated with graft age. HBV infection and late acute rejection are common associated findings. Abnormal TE and/or LFTs may guide physicians to consider liver biopsy for the detection of late allograft fibrosis in LT children.     

Development of autoantibodies after pediatric liver transplantation

Dn‐AIH is a long‐term complication after LT. The aim of this study was to analyze the occurrence of autoantibodies in pediatric recipients and the clinical significance. From 1992 to 2008, 96 pediatric LT for non‐autoimmune liver diseases were performed in 94 children in our institution. Serum autoantibodies were checked in 68 subjects (73.9%). A positive autoantibody was defined as titers ≥1:40 for ANA, or ≥1:20 for ASMA, anti‐LKM, and AMA. Autoantibodies were detectable in 51 of 68 patients (75.0%). There was positivity for ANA in 30 patients, ASMA in 32, and AMA in three, while anti‐LKM was all negative. Immunosuppressive treatment with CsA, more than one episode of rejection, and abnormal ALT were risk factors for the development of autoantibodies. The incidence of the development of autoantibodies was 75.0% in pediatric LT cases in this study. ASMA was the most commonly found autoantibody. Autoantibodies may not play a sentinel role for dn‐AIH after LT.     

不同肥胖程度儿童罹患心血管代谢异常风险的横断面调查

目的 通过对肥胖学生健康评估体检,了解不同肥胖程度儿童青少年罹患高血压、高血糖和血脂异常等心血管代谢异常风险现况。方法 采用现况调查方法,对北京市西城区、海淀区和密云县17所中小学2012至2013年度参加学校常规年度体检并以BMI为评价指标筛查为肥胖的学生,进行以健康风险评估为目的的临床体检,体检内容包括体量（身高、体重及体质成分）,血压,空腹血糖,血脂（总胆固醇、三酰甘油、高密度脂蛋白和低密度脂蛋白）等指标。采用中国肥胖问题工作组（WGOC）制定的BMI超重、肥胖筛查标准判定肥胖状态;采用中国儿童青少年血压参照标准评定儿童高血压;采用儿童青少年血脂异常防治专家共识推荐的中国2岁以上儿童青少年血脂异常诊断标准判断血脂异常;以空腹血糖作为评价指标,采用美国糖尿病联盟推荐糖尿病诊断和分类标准进行评价。结果 1 809/3 227名(56.1%)肥胖学龄儿童青少年完成了现况调查且具有完整体检数据,平均年龄12.2岁。肥胖学生心血管代谢异常指标检出率分别为：高血压30.8%,血脂异常43.3%,糖尿病和空腹血糖受损66.6%,肝功能异常11.6%,脂肪肝16.0%,黑棘皮症21.9%。肥胖男生高血压、空腹血糖受损、肝功能异常、脂肪肝和2项及以上心血管代谢异常检出率均高于肥胖女生。重度肥胖占总肥胖人数的29.9%,协方差分析调整年龄和性别后,重度肥胖学生高血压、肝功能异常、脂肪肝、黑棘皮症和2项及以上心血管代谢异常检出率均高于轻中度肥胖学生。结论 肥胖儿童青少年高血压、高血糖和血脂代谢紊乱等心血管代谢异常高发,心血管代谢异常随肥胖程度增加呈上升趋势;儿童肥胖相关心血管代谢异常高发需要得到更广泛关注。