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Pediatr Transplant. 2019 Aug;23(5):e13476. doi: 10.1111/petr.13476. Epub 2019 May 24.

New-onset diabetes after pediatric heart transplantation: A review of the Pediatric Heart Transplant Study.

Author information

1
University of Louisville, Louisville, Kentucky.
2
University of Alabama at Birmingham, Birmingham, Alabama.
3
Duke University Medical Center, Durham, North Carolina.
4
Baylor College of Medicine, Houston, Texas.
5
Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
6
University Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
7
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
8
Children's Medical Center, Dallas, Texas.

Abstract

NDT is a well-defined complication after solid organ transplantation. Little has been published describing the incidence, risk factors, and effect on outcome after pediatric heart transplantation. We performed a retrospective evaluation of pediatric patients from the PHTS registry from 2004 to 2014. Group comparison, associated factors, incidence using Kaplan-Meier method, and risk factor and outcome analysis for NDT at 1 year post-transplant. Of the 2185 recipients, 1756 were alive and followed at 1 year. Overall freedom from NDT was 98.9%, 94.7%, and 92.6% at 1, 5, and 10 years, respectively. Patients with NDT were more likely to be black (non-Hispanic; P = 0.002), older at time of transplant (P < 0.0001), and have a higher BMI percentile at time of transplant (P < 0.0001). Adjusted risk factors for NDT at 1 year were older age at transplant (years; >12 years, OR: 8.8 and 5-12 years, HR: 8.0), obese BMI percentile at time of transplant (OR: 3.8), and steroid use at 30 days after transplant (OR: 4.7). Though uncommon, NDT occurs with a constant hazard after pediatric heart transplant; it occurs more often in older patients at transplant, those who are of black race, those who are obese, and those who use steroids. Therefore, targeted weight reduction and selective steroid use in at-risk populations could reduce the incidence of early NDT. Further data are needed to determine the risk imparted by transplantation, factors that predict late-onset NDT, and whether NDT alters the outcome after transplant.

KEYWORDS:

diabetes; heart transplant; pediatric

PMID:
31124221
DOI:
10.1111/petr.13476

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