Cardiovascular Risk in Pediatric Transplant Patients

Douglas Mark Silverstein, MD, Principal Investigator
Research Associate

Abstract
Pediatric renal transplant recipients are at high risk for the development of cardiovascular disease (CVD). The risk factors for CVD in pediatric renal transplant recipients include renal insufficiency, hyperlipidemia, hyperhomocysteinemia, inflammation, malnutrition, anemia, and hyperglycemia/insulin resistance. There are few studies that have explored the incidence of risk factors for CVD in these patients. In addition, there are no studies that have simultaneously measured multiple risk factors for CVD in this population. Although many pediatric renal transplant patients exhibit left ventricular hypertrophy, many of them have normal ambulatory blood pressure values, suggesting that risk factors aside from hypertension predispose them to CVD.

HYPOTHESIS: We are speculating that there is a high prevalence of multiple risk factors for CVD in pediatric renal transplant patients, placing them at risk for morbidity and mortality from cardiac disease.

SPECIFIC AIMS:

1) Simultaneously assess:

a) Renal function

b) Serum lipid profile

c) Serum homocysteine

d) Inflammation: serum cytokines IL-1ß, TNF-a, IL-6, and IL-10 and C-reactive protein

e) Anemia: Hemoglobin and hematocrit

f) Nutrition: Serum albumin and prealbumin; Serum vitamin C, B6, B12 and folate

g) Serum glucose and serum insulin

2) Assess cardiovascular function by:

b) Blood pressure

b) Electrocardiogram and echocardiogram

c) Exercise stress testing

We will establish risk scores and identify patients who are at the highest risk for significant morbidity and mortality for CVD

Collaborations
H. Jorge Baularte, Children's Hospital of Philadelphia
Sandi M. See Tai, St. Christopher's Hospital for Children

Sponsor: NIH
Duration: 04/04 - 03/06