Sandeep Brar1,2, Stephanie N Dixon3,4,5, J Michael Paterson6,7, Jade Dirk3,4, Emma Hahn3,4, S Joseph Kim3,7,8,9, Vicky Ng9,10, Melinda Solomon9,11, Jovanka Vasilevska-Ristovska12, Tonny Banh12, Paul C Nathan6,9,13, Rulan S Parekh14,15,16,17, Rahul Chanchlani18,19. 1. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. 2. Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada. 3. ICES Western, London, ON, Canada. 4. Lawson Health Research Institute, London, ON, Canada. 5. Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. 6. ICES Central, Toronto, ON, Canada. 7. Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 8. Division of Nephrology and the Ajmera Transplant Centre, University Health Network, Toronto, Canada. 9. Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 10. Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 11. Division of Respiratory Medicine, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 12. Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada. 13. Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada. 14. Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. rulan.parekh@wchospital.ca. 15. Faculty of Medicine, University of Toronto, Toronto, ON, Canada. rulan.parekh@wchospital.ca. 16. Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. rulan.parekh@wchospital.ca. 17. Academics, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada. rulan.parekh@wchospital.ca. 18. Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada. 19. Division of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Abstract
BACKGROUND: With improved survival among children after transplantation, our understanding of the risk for developing other comorbidities is improving, yet little is known about the long-term risk of cardiovascular events and mortality after solid organ transplantation. METHODS: In a cohort study using health administrative data, we compared cardiovascular events in children (n = 615) with liver, lung, kidney, small bowel, or multi-organ transplant at the Hospital for Sick Children, Toronto, Canada, with asthmatic children (n = 481,697) between 1996 and 2014. Outcomes included non-fatal cardiovascular events, cardiovascular death, all-cause mortality, and a composite of non-fatal and fatal cardiovascular events. Time-stratified Cox proportional hazards models were used. RESULTS: Among 615 children, 317 (52%) were recipients of kidneys, 253 (41%) of livers, and the remaining 45 (7%) had lung, small bowel, or multi-organ transplants. Median follow-up was 12.1 [7.2, 16.7] years. Non-fatal incident cardiovascular events were 34 times higher among solid organ transplant recipients than non-transplanted children (incidence rate ratio (IRR) 34.4, 95% CI: 25.5, 46.4). Among transplant recipients, the cumulative incidence of non-fatal and fatal cardiovascular events was 2.3% and 13.0%, 5 and 15 years after transplantation, respectively. CONCLUSIONS: Increased rate of cardiovascular events in children after transplantation highlights the need for surveillance during transition into adulthood and beyond. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: With improved survival among children after transplantation, our understanding of the risk for developing other comorbidities is improving, yet little is known about the long-term risk of cardiovascular events and mortality after solid organ transplantation. METHODS: In a cohort study using health administrative data, we compared cardiovascular events in children (n = 615) with liver, lung, kidney, small bowel, or multi-organ transplant at the Hospital for Sick Children, Toronto, Canada, with asthmatic children (n = 481,697) between 1996 and 2014. Outcomes included non-fatal cardiovascular events, cardiovascular death, all-cause mortality, and a composite of non-fatal and fatal cardiovascular events. Time-stratified Cox proportional hazards models were used. RESULTS: Among 615 children, 317 (52%) were recipients of kidneys, 253 (41%) of livers, and the remaining 45 (7%) had lung, small bowel, or multi-organ transplants. Median follow-up was 12.1 [7.2, 16.7] years. Non-fatal incident cardiovascular events were 34 times higher among solid organ transplant recipients than non-transplanted children (incidence rate ratio (IRR) 34.4, 95% CI: 25.5, 46.4). Among transplant recipients, the cumulative incidence of non-fatal and fatal cardiovascular events was 2.3% and 13.0%, 5 and 15 years after transplantation, respectively. CONCLUSIONS: Increased rate of cardiovascular events in children after transplantation highlights the need for surveillance during transition into adulthood and beyond. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Eba H Hathout; Richard E Chinnock; Joyce K Johnston; James A Fitts; Anees J Razzouk; John W Mace; Leonard L Bailey Journal: Am J Transplant Date: 2003-08 Impact factor: 8.086
Authors: Herwig-Ulf Meier-Kriesche; Jesse D Schold; Titte R Srinivas; Alan Reed; Bruce Kaplan Journal: Am J Transplant Date: 2004-10 Impact factor: 8.086
Authors: Mark M Mitsnefes; Thomas R Kimball; William L Border; Sandra A Witt; Betty J Glascock; Philip R Khoury; Stephen R Daniels Journal: Am J Kidney Dis Date: 2004-04 Impact factor: 8.860