Charles Baum

Predictors of Weight Gain and Cardiovascular Risk in a Cohort of Racially Diverse Kidney Transplant Recipients

OBJECTIVE Renal transplantation is associated with an increased risk of atherosclerotic cardiovascular disease and marked racial and ethnic disparities in graft and patient survival. We characterized differences in racial and ethnic susceptibility to weight gain, diabetes, and alterations in circulating lipid levels and isolated independent predictors of those changes in a diverse population of kidney transplant recipients. METHODS The data for this analysis were drawn from a prospectively collected database of 506 renal transplant recipients obtained between 1983 and 1998. Univariate and multivariate analyses characterized differences in outcomes and predictors of cardiovascular risk by race and ethnicity. RESULTS In all recipients, coronary artery disease was the most common cause of death, and African-American recipients had the shortest graft survival and the highest percentage of deaths. At 1 y post-transplantation, 39% of African-American recipients were obese (body mass index > 30), and the odds ratios for post-transplant diabetes were 3.5 and 5 times greater in non-white and obese recipients, respectively. CONCLUSIONS Multiple regression analysis confirmed the predominant independent effect of African American race or ethnicity on weight gain; however, hypercholesterolemia was independent of race or ethnicity and predicted by cyclosporine treatment and post-transplant diabetes. Therefore, kidney transplantation represents a state of accelerated atherogenic risk induced in part by the metabolic effects of immunosuppressive medications and compounded by marked racial and ethnic disparities in weight gain and diabetes risk.

Progressive functional adaptation of segmental bowel graft from living related donor

We report a patient with short gut syndrome successfully treated with living related bowel transplantation. A 27-year-old Caucasian man was referred after traumatic loss of almost the entire bowel from the third portion of duodenum to the sigmoid colon. His HLA-identical sister volunteered as a donor. A 200-cm segment of ileum was successfully transplanted under tacrolimus-based immunosuppression. The posttransplant course was uneventful, without rejection or infectious complication. Total parenteral nutrition was discontinued 1 week posttransplant. At 6 months the patient had returned to his preinjury weight. Water and D-xylose absorption as well as fecal fat studies were markedly abnormal 1 month posttransplant but normalized by 6 months. The donor recovery was uneventful. A well-matched segmental ileal graft from living donor can provide complete rehabilitation for patients with short gut syndrome. We documented a progressive functional adaptation of the ileal graft, resulting in normal absorption by 5 months posttransplantation.

Seasonal patterns of abdominal pain consultations among adults and children.

Background and Aim: Consultations for chronic abdominal pain are frequent in adults and children. A seasonal pattern of abdominal pain consultations with winter predominance was shown in previous pediatric studies; however, no studies have investigated whether such a pattern exists in adult patients. Understanding the differences in seasonal patterns of abdominal pain consultations among adults and children may indicate that either different mechanisms exist for common chronic pain conditions or triggering factors may vary by age. The aim of the study was to investigate whether a seasonal variation in abdominal pain consultation patterns exists among adults and children. Methods: The number of outpatient consultations among children (5–17 years) and adults (18 years or older) with a diagnosis of abdominal pain of nonspecified origin (International Classification of Diseases-9 code 789.0) from May 2000 to December 2008 was identified in an administrative claims database. The primary outcome measure was the rate of abdominal pain consultations (total number of abdominal pain consultations/total number of distinct patients by month × 1000) by season in children and adults. Seasons were defined as follows: winter (December–February), spring (March–May), summer (June–August), and fall (September–November). A trend test was conducted to determine the degree of linearity in the patterns between the 2 groups. Among children, subanalyses by age 5 to 11 years and 12 to 17 years and sex were conducted. Results: A total of 172.4 million distinct patients (13.4% children, 87.6% adults) were identified in the database between May 2000 and December 2008. During the same time period, 15.6 million patient consultations for abdominal pain were identified (10.1% children, 89.9% adults). Children demonstrated a seasonal pattern in abdominal pain consultations, which best fit a quadratic regression curve, with consultations less common during the summer months. Abdominal pain consultations in adults were linear with no seasonal predominance. The trend in seasonal variation of abdominal pain consultations among children stratified by age and sex remained consistent with the overall child population. Conclusions: Abdominal pain consultations in children are less common during summer months, whereas no evidence of seasonal pattern of consultation was found in adults. Factors involved in the pathogenesis of abdominal pain in adults and children may differ.

M1323 Chronic Constipation and Co-Morbidities: A Prospective Population-Based Nested Case-Control Study

Background: Chronic constipation (CC) is common in the community but surprisingly little is known about relevant gastrointestinal (GI) and non-GI co-morbidities. Objective: The purpose of this study was to assess the epidemiology of CC and in particular provide new insights into the co-morbidities linked to this condition. Methods: In a prospective, population-based nested case-control study, a cohort of randomly selected community residents (n ¼8006) were mailed a validated self-report gastrointestinal symptom questionnaire. CC was defined according to Rome III criteria. Medical records of each case and control were abstracted to identify potential CC comorbidities. Results: Altogether 3831 (48%) subjects returned questionnaires; 307 met criteria for CC. Age-adjusted prevalence in females was 8.7 (95% confidence interval (CI) 7.1–10.3) and 5.1 (3.6–6.7) in males, per 100 persons. CC was not associated with most GI pathology, but the odds for constipation were increased in subjects with anal surgery relative to those without (odds ratio (OR) ¼3.3, 95% CI 1.2–9.1). In those with constipation vs those without, neurological diseases including Parkinson’s disease (OR ¼6.5, 95% CI 2.9–14.4) and multiple sclerosis (OR ¼5.5, 95% CI 1.9–15.8) showed significantly increased odds for chronic constipation, adjusting for age and gender. In addition, modestly increased odds for chronic constipation in those with angina (OR ¼1.4, 95% CI 1.1–1.9) and myocardial infarction (OR ¼1.5, 95% CI 1.0–2.4) were observed. Conclusions: Neurological and cardiovascular diseases are linked to constipation but in the community constipation is unlikely to account for most lower GI pathology.