*Purpose: Cardiovascular (CV) events account for 8-13% of deaths after liver transplantation (LT) in adulthood. While CV risk factors are present in children after LT little is known about the prevalence of subclinical CV damage.

*Methods: We annually assessed subclinical CV damage by measuring intima-media thickness (IMT, a marker for atherosclerosis), pulse-wave velocity (PWV, signifying arteriosclerosis), and the left-ventricular mass index (LVMI, as parameter for left-ventricular hypertrophy) in 110 pediatric LT recipients (aged 11.4 ± 3.7 years) over a period of 4.6 years in a prospective longitudinal observational study (n=83 for F/U1, n=62 for F/U2, n=35 for F/U3, n=15 for F/U4).

*Results: At inclusion, elevated IMT was present in 59%, elevated PWV in 24%, left-ventricular hypertrophy in 10%. Mixed linear modeling including all observations identified younger age at LT, shorter time since LT, decreased renal function, and low vitamin D levels to be independently associated with IMT, and higher albumin/creatinine ratio, higher systolic blood pressure and the presence of microinflammation for PWV. Older Age at LT, longer time since LT and less physical activity were an independent predictor of higher LVMI.

*Conclusions: Pediatric LT recipients display relevant subclinical CV target organ damage. Apart from immutable factors, such as age at LT, we could identify modifiable risk factors (such as blood pressure, renal disease, hypovitaminosis D) contributing to CV damage that could serve as targets for preventive measures. In light of excellent long-term survival in this patient collective, CV morbidity needs to be addressed.

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