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OBJECTIVE: The aim of the study is to identify early predictors of long-term overweight and obesity in pediatric liver transplant recipients. METHODS: Single-center, retrospective review of children who underwent liver transplant before age 6 years. Body mass index (BMI), weight, and height percentiles at transplant and post-transplant were calculated. BMI, weight gain trajectories, and failure-to-thrive (FTT) were examined as predictors of overweight/obesity at 3 and 5 years post-transplant. RESULTS: Children (n = 70) were median 0.9 years at transplant. Median BMI percentile increased from 37 (interquartile range (IQR) 12-73) at transplant to 83 (IQR 64-97) at 12 months, with median weight percentile 47 (IQR 26-67) and height percentile 9 (IQR 2-32). Overweight/obesity prevalence peaked at 3 years post-transplant (44%). Children who were overweight/obese at 3 years post-transplant were more likely to be overweight/obese at transplant, and at 6 and 12 months post-transplant (odds ratio (OR): 9.4, P = 0.02; OR: 6.7, P = 0.013, OR: 6.4, P = 0.007, respectively). The prevalence of overweight/obesity decreased to 26% at 5 years. Rapid weight gain post-transplant did not predict overweight/obesity at 3 or 5 years. Over one-third of children who were FTT at transplant were overweight/obese at 3 or 5 years, but FTT at transplant did not increase later obesity risk. CONCLUSIONS: Most children gain weight rapidly after liver transplant. Nearly half of transplant recipients are overweight/obese at 3 years, but the prevalence decreases by 5 years. Those who become overweight/obese tend to do so within 1 year post-transplant, making this an important time to identify high-risk children and provide counseling.

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In adult liver transplant recipients, the donor body mass index (dBMI) is associated with posttransplant obesity but not with graft or patient survival. Because of the obesity epidemic in the United States and the already limited supply of liver donors, clarifying whether the dBMI affects pediatric outcomes is important. United Network for Organ Sharing data for pediatric liver transplants in the United States (1990-2010) were evaluated. Data on transplants performed between 2004 and 2010 (n = 3788) were used for survival analyses with Kaplan-Meier and Cox proportional hazards models and for posttransplant obesity analyses with generalized estimating equations. For children receiving adult donor livers, a dBMI of 25 to <35 kg/m(2) was not associated with graft or patient survival in univariate or multivariate analyses. A dBMI ≥ 35 kg/m(2) increased the risk of graft loss [hazard ratio (HR) = 2.54, 95% confidence interval (CI) = 1.29-5.01, P = 0.007] and death (HR = 3.56, 95% CI = 1.64-7.72, P = 0.001). For pediatric donors, the dBMI was not associated with graft loss or mortality in a univariate or multivariate analysis. An overweight or obese donor was not a risk factor for posttransplant obesity. Overweight and obesity are common among liver transplant donors. This analysis suggests that for adult donors, a body mass index (BMI) of 25 to <35 kg/m(2) should not by itself be a contraindication to liver donation. Severe obesity (BMI ≥ 35 kg/m(2)) in adult donors increased the risk of graft loss and mortality, even after adjustments for recipient, donor, and transplant risk factors. Posttransplant obesity was not associated with the dBMI in this analysis. Further research is needed to clarify the impact of donor obesity on pediatric liver transplant recipients.

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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.

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This study surveyed pediatric primary care providers at a major academic center regarding their attitudes and practices of obesity screening, prevention, and treatment. The authors compared the care providers' reported practices to the 2007 American Medical Association and Centers for Disease Control and Prevention Expert Committee Recommendations to evaluate their adherence to the guidelines and differences based on level of training and specialty. Of 96 providers surveyed, less than half used the currently recommended criteria for identifying children who are overweight (24.7%) and obese (34.4%), with attendings more likely to use the correct criteria than residents (P < .05). Although most providers felt comfortable counseling patients and families about the prevention of overweight and obesity, the majority felt their counseling was not effective. There was considerable variability in reported practices of lab screening and referral patterns of overweight and obese children. More efforts are needed to standardize providers' approach to overweight and obese children.

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