Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation: what are we dealing with, and what can we target?

Adult and late adolescent complications of pediatric solid organ transplantation

“…10 Interventions using pedometer and active video games resulted in no increase in physical activity unless it was directly tied to a reward. 10 In 2023 the American Academy of Pediatrics released recommendations for management of obesity in children and adults that included intensive lifestyle modification including at least 26 h of face-to-face family-based interventions and suggested pharmacotherapy and surgical weight loss interventions for select patients. 19 However, data on such interventions in pediatric transplant patients are "nonexistent."…”

“…Hypertension has been reported in 19%-23.8% of liver and 60%-90% of kidney recipients and is more prevalent among patients on tacrolimus-and steroidbased immunosuppression. 6,9,10 Hyperlipidemia has been reported in as many as 50% of adult survivors of pediatric SOT, 11 with hypertriglyceridemia and low high-density lipoprotein (HDL) being especially common, [4][5][6] potentially related in part to cyclosporine and F I G U R E 1 Incidence of (A) nonfatal composite of cardiovascular disease events; (B) cardiovascular disease mortality; (C) nonfatal and fatal cardiovascular composite; and (D) all-cause mortality among pediatric transplant recipients and nontransplanted asthma cohort. Originally published by Brar et al Pediatric Nephrology copyright Springer 2023, reprinted with permission.…”

“…[12][13][14] Excessive weight gain within the first four months posttransplant is common in kidney transplant recipients, who report similar low levels of physical activity as pediatric dialysis patients. 10 In addition to hypertension and dyslipidemia, chronic kidney disease is an independent risk factor for cardiovascular disease that has been reported in 23% of pediatric intestine recipients, 19% of pediatric liver recipients, and 12% of pediatric lung recipients. 5 Beyond the traditional cardiovascular risk factors, there is accumulating evidence of subclinical cardiovascular disease is present among pediatric SOT recipients during childhood.…”

“…Randomized controlled trials of low‐sodium diet counseling in Japan and the United States both showed improved blood pressure during the study, but failed to demonstrate sustained benefit after the study was complete 10 . Interventions using pedometer and active video games resulted in no increase in physical activity unless it was directly tied to a reward 10 . In 2023 the American Academy of Pediatrics released recommendations for management of obesity in children and adults that included intensive lifestyle modification including at least 26 h of face‐to‐face family‐based interventions and suggested pharmacotherapy and surgical weight loss interventions for select patients 19 .…”

“…Overall, 58% of pediatric liver recipients, 6 over 20% of heart recipients, 7 and 33% of kidney recipients 8 are estimated to have at least two cardiovascular risk factors. Hypertension has been reported in 19%–23.8% of liver and 60%–90% of kidney recipients and is more prevalent among patients on tacrolimus‐ and steroid‐based immunosuppression 6,9,10 . Hyperlipidemia has been reported in as many as 50% of adult survivors of pediatric SOT, 11 with hypertriglyceridemia and low high‐density lipoprotein (HDL) being especially common, 4‐6 potentially related in part to cyclosporine and mammalian target of rapamycin (mTOR) inhibitor immunosuppressants.…”