Obesity in Pediatric Transplant and the Use of Liraglutide

Abstract

<h3>Introduction</h3> Obesity and metabolic disorders are associated with increased mortality post heart transplant. We report the case of a 17-year-old female with obesity pre and post transplant obesity whose body mass index (BMI) and metabolic profile improved with the GLP-1 analog, liraglutide. <h3>Case Report</h3> AG is a 17 year-old diagnosed with Dannon syndrome, an X-linked disorder, characterized by a triad of arrhythmia, muscle weakness and cardiomyopathy. Due to progressive decline in ventricular systolic function, she underwent heart transplantation. Her weight was 106.4 kg and BMI 34.35 kg/m² at the time of transplant. Post-transplant, despite healthy lifestyle recommendations, weight management and nutrition clinics, AG's hyperphagia persisted and her BMI continued to increase. AG was started on liraglutide and she lost 17kg over 6 months (Fig. 1). Her BMI improved from 38 kg/m² to 32 kg/m². Her HgbA1c normalized and lipid profile also improved. AGs only complaint was of nausea and vomiting however these symptoms were related to her immunosuppression medications and improved after adjusting her regimen. <h3>Summary</h3> Use of behavioral interventions to improve BMI pre- and post-transplant is of limited success in lowering BMI. The U.S. Food and Drug Administration approved liraglutide for chronic weight management among patients aged 12 and older with obesity. Liraglutide, a long-acting analog of human glucagon-like peptide-1, increases glucose-dependent insulin secretion, decreases inappropriate glucagon secretion, increases B-cell growth/replication, and slows gastric emptying. This case demonstrated successful use of liraglutide to aid in weight loss in a post-transplant pediatric patient. Among motivated patients who maintain good communication with their clinician and adhere to a multidisciplinary approach, this regimen can improve previously unattainable weight loss goals. Close monitoring for side effects is crucial especially in populations where confounding regimens may require dose adjustments.