Citations 2
MRI Analysis of Cardiac Fat, Abdominal Adiposity and Cardiac Function After Vertical Sleeve Gastrectomy in Youth With Type 2 Diabetes
Dobbs, Tyler , Gutierrez, Linnea, Hunter, Kendall S. , Fonseca, Brian, Browne, Lorna P. , Winter, D. , Cree‐Green, Melanie , Pyle, Laura , Hills‐Dunlap, Jonathan L. , Reusch, Jane E.B. , Dobbs, Tyler J , Hu, Houchun Harry , Inge, Thomas H , Gutierrez, Linnea, Hu, Peng , Winter, David, Kelsey, Megan Moriarty , Inge, Thomas H. , Bjornstad, Petter , Nadeau, Kristen J
Pediatric Obesity | November 18, 2025 | Volume: 21 | Issue: 1 | Pages: No page available
ABSTRACT Background Adolescents with youth‐onset type 2 diabetes (YO‐T2D) have an increased risk for cardiometabolic complications. The impact of vertical sleeve gastrectomy (VSG) on fat distribution and cardiac morphology/function in YO‐T2D is unknown. Objectives To evaluate changes in body composition, abdominal and cardiac fat depots, and cardiometabolic health in adolescents with YO‐T2D undergoing VSG. Methods Anthropometrics, labs and imaging were used to assess participants pre‐surgery and 3–12 months post‐surgery. MRI quantified pericardial (PAT), epicardial (EAT), subcutaneous (SAT) and visceral adipose tissue (VAT), hepatic fat fraction (HFF) and cardiac morphology/function. Mixed‐effects models assessed longitudinal changes. Results By 12 months, weight decreased from 134.3 ± 5.1 to 103.3 ± 5.2 kg, VAT 1943 ± 148 to 1248 ± 150 cm 3 , HFF 23.2% ± 2.3% to 5.3% ± 2.3% and PAT and EAT by 27% and 33% (all p < 0.01). Homeostatic model assessment of insulin resistance (HOMA‐IR) improved (7.8 ± 1.2 to 1.7 ± 1.2 [ p < 0.01]). BMI, SAT, resting heart rate (RHR), left ventricular (LV) mass and cardiac output (CO) also decreased (all p < 0.05). VAT decreases correlated with decreases in HFF ( r = 0.70, p = 0.01), HOMA‐IR ( r = 0.60, p = 0.04) and CO ( r = 0.70, p = 0.03). HFF decreases correlated with decreases in BMI ( r = 0.70, p = 0.03), HOMA‐IR ( r = 0.90, p < 0.001), RHR ( r = 0.90, p = 0.002), CO ( r = 0.80, p = 0.007) and LV mass ( r = 0.70, p = 0.02). Conclusions VSG reduces ectopic and regional fat and improves associated insulin sensitivity and cardiac health in adolescents with YO‐T2D.
Everolimus and Low-Dose Tacrolimus After Heart Transplant in Children
Almond, Christopher S. , Alejos, Juan , Ameduri, Rebecca , Barkoff, L., Barnes, Aliessa, Butto, Arene , Carlo, Waldemar F. , Chrisant, Maryanne , Dreyer, William J. , Everitt, Melanie D. , Gonzales, S., Hollander, Seth A. , Kindel, Steven J. , Klein, Gloria L., Lamour, Jacqueline M. , Lee, Joanne , Lü, Minmin , Lytrivi, Irene D. , Miyamoto, Shelley D. , Pahl, Elfriede , Peng, David M. , Sutcliffe, David , Ybarra, A., Zangwill, Steven , Rossano, Joseph W. , Investigators, TEAMMATE Trial, Choi, Jua , Wilber, Jared, Sutherland, Scott M. , Feng, Dana, Lagerborg, Kendra, Burns, Julia, Nikolli, Kledja, Twombly, Adrianna, Massey, Linda K., Wartick, Jennifer, Yohannes, Kifle, Gupta, Akanksha , Major, Melissa , Blume, Elizabeth D. , Esteso, Paul , VanderPluym, Christina , Bastardi, Heather , MacLean, Matthew T. , Haschke, Paul, Gibbons, Taylor , Vu, Courtney , Reilly, Sydney, Ha, Lynne, Boyle, Carley, Robie, Sharon L., Ogata, Kay, Knecht, Carlos, Browne, Lorna P. , Malone, LaDonna J. , Gordon, Megyn, Molina, Kimberly , Cabrera, Antonio G. , Lambert, Linda, Fullerton, Chase, Thompson, Kate J., Cardon, Michelle, Timmer, Amanda, Nelson, Michelle , Ramstack, Dani, Heyrend, Carly, Benefield, Emily C., Roberson, Teresa, Butts, Ryan J. , Martinez, Maria , Pottorre, Simi, Burgardt, Laura, Armstrong, Blake, Zamberlan, M. , McCormick, Amanda D. , Bartsch, Jaynee, Mahle, William T. , Burnett, Meilssa, Pietra, Biagio A. , Breault, Leah, Friedland‐Little, Joshua , Prakash, Ranjini, Lee, Anne CC , Brody, Linnea, Huberts, Avery, Noon, Kelli, Guadiz, Donna, Garcia, Allison, Addonizio, Linda J. , Repp, Arielle, Cornelius, C.E. , Abraham, Margaret, Rose-Felker, Kristen, Moninger, Allison, Huston, Allison, Berman, Pamela, Ploutz, Michelle , Wisotzkey, Bethany , Grohall, Stacey, Colon, April, Churosh, Jenny, Cordova, Renee, Smith, Paulette, Kornetsky, Susan , Mitchell, Anna, Alderson, Daniel, Dominguez, R Blanco, Gawlowicz, Kennan, Lipsitz, Stuart R. , Eisen, Howard J. , Jeewa, Aamir , Uber, Patricia A., Thakar, Rahul, Ellsworth, Darrell L. , McCormick, A , Peng, D M , Daly, Kevin P , Albers, Erin L. , Auerbach, Scott R. , Bock, Matthew J. , Castleberry, Chesney , Deshpande, Shriprasad R. , Feingold, Brian , Lal, Ashwin K. , Ryan, Thomas D. , Singh, Tajinder P. , Su, Jennifer A. , Sleeper, Lynn A. , Investigators, TEAMMATE Trial, Wilber, Jared, Nikolli, Kledja, Massey, Linda, Wartick, Jennifer, Major, Melissa, MacLean, Matthew, Lee, JungWoo, Joong, Anna , Reilly, Sydney, Kuhn, Michael, Ogata, Kay, Knecht, Carol, Gordon, Megyn, Hansen, Lisa, May, Lindsay J. , Lambert, Linda, Fullerton, Chase, Thompson, Kate, Timmer, Amanda, Heyrend, Carly, Martinez, Maria, Schumacher, Kurt R. , Lim, Heang M. , Bartsch, Jaynee, Burnett, Meilssa, Prakash, Ranjini, Lee, Anne CC , Brody, Linnea, Huberts, Avery, Noon, Kelli, Guadiz, Donna, Repp, Arielle, Bansal, Neha , Hsu, Daphne T. , Cornelius, Chelsea, Padilla, Luz A. , Churosh, Jenny, Cordova, Renee, Mitchell, Anna, Alderson, Daniel, Dominguez, Robleinscky, KOBASHIGAWA, JON A. , Wightman, Aaron G.
JAMA | September 17, 2025 | Volume: 334 | Issue: 15 | Pages: 1339
ImportanceStudies suggest that everolimus may reduce the risk of rejection, cardiac allograft vasculopathy (CAV), chronic kidney disease (CKD), and cytomegalovirus (CMV) after heart transplant. Everolimus use is controversial because of data demonstrating higher infection deaths when everolimus is introduced de novo after transplant. It is unclear whether everolimus is safe and effective when initiated at 6 months posttransplant in children, a population in which median graft survival is limited to 15 years and randomized clinical trials are lacking.ObjectiveTo evaluate the safety and efficacy of everolimus combined with low-dose tacrolimus to prevent major adverse transplant events (MATEs) in children after heart transplant.Design, Setting, and ParticipantsMulticenter, randomized, open-label, clinical trial enrolling 211 patients who were alive 6 months after pediatric heart transplant at 25 US sites from February 2018 to August 2020. The last date of follow-up was April 17, 2023.InterventionsParticipants were randomized to receive everolimus and low-dose tacrolimus (n = 107) or standard-dose tacrolimus and mycophenolate mofetil (n = 104) for 30 months.Main Outcomes and MeasuresThe primary efficacy end point was the MATE-3 score at 30 months, a validated composite ordinal end point including acute cellular rejection, CAV, and CKD. The primary safety end point was the MATE-6 score, encompassing the MATE-3 score plus antibody-mediated rejection, infection, and posttransplant lymphoproliferative disorder.ResultsAmong 211 children randomized, the mean age was 8.2 (SD, 6.3) years, 97 (46%) underwent transplant for congenital heart disease, and 49 (23%) were treated for rejection before 6 months. At 30 months, the mean MATE-3 score did not differ between the 2 treatment groups (mean difference, −0.32; 95% CI, −0.90 to 0.20; P = .16). The mean MATE-6 score was no higher in the everolimus group than in the mycophenolate group (baseline-adjusted mean difference, −0.40; 95% CI, −1.81 to 0.93), meeting the success criterion for safety (noninferiority margin &lt;3). There were no differences in graft survival, MATE-free survival, or freedom from any individual MATE. Everolimus was associated with greater improvement in estimated glomerular filtration rate at 12 months (mean difference, 10.5 mL/min/1.73 m2; 95% CI, 1.09-19.91 mL/min/1.73 m2) and a lower incidence of CMV infection (hazard ratio, 0.50; 95% CI, 0.26-0.93).Conclusions and RelevanceAmong 6-month pediatric heart transplant survivors, everolimus and low-dose tacrolimus did not differ from tacrolimus and mycophenolate in preventing the composite of cellular rejection, CAV, and CKD at 30 months. However, everolimus and low-dose tacrolimus appear to be safe based on the total burden of 6 MATEs and may be associated with improved kidney function and less CMV infection.Trial RegistrationClinicalTrials.gov Identifier: NCT03386539