Shorter leukocyte telomere length in pediatric patients who have undergone liver transplantation for conditions such as Alagille syndrome (ALGS) tends to be associated with higher intima-media thickness and aspartate aminotransferase, according to an article published in Liver Transplantation.

These results suggest that early biological aging may contribute to subclinical cardiovascular damage and could affect the health of the graft in these liver transplant patients.

During the study, higher intima-media thickness was associated with shorter leukocyte telomere length in the pediatric patients after correcting for age, sex, and age at transplant. Previous associations have been observed between intima-media thickness and leukocyte telomere length in older adults and adults with cardiovascular risk but not in healthy pediatric or adolescent participants.

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Leukocyte telomere length in the overall patient cohort was found to be considerably shorter than published values for healthy children. A negative slope in leukocyte telomere length was found in 45% of the patients involved in the study, with an average leukocyte telomere length shortening of 0.09 per year after adjustment for sex, age, and age at transplantation.

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The 55% of patients with “stable leukocyte telomere length” showed a small but significant decrease in intima-media thickness per year (-0.02 mm/year; P =.04) and a reduction in tacrolimus trough levels (-0.08 μg/L/year; P =.03) compared to patients with shortening leukocyte telomere length, who had no change in intima-media thickness levels each year (0.0 mm/year) and an increase in tacrolimus trough levels (0.41 μg/L/year).

“Whether telomere-mediated cell senescence constitutes a causative underlying mechanism for subclinical atherosclerosis or whether it represents an epiphenomenon caused by [cardiovascular] risk factors remains to be elucidated. In both cases, monitoring [leukocyte telomere length] shortening may aid in identifying patients that are at risk for [cardiovascular] disease after pediatric liver transplantation,” the authors suggested.

During the study, 97 pediatric liver allograft recipients (including 4 patients with ALGS) were recruited. The median age of the patients was 10.7 years, with a median time since transplantation of 6.7 years.


Memaran N, Wilke H, Sugianto RI, et al. Telomere length is associated with intima-media thickness in pediatric liver transplant patients: a prospective cohort study. Liver Transpl. Published online June 6, 2022. doi:10.1002/lt.26524