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Growth in children following liver transplantation
R A Superina1, A Zangari, L Acal
1Liver Transplant Program, The Hospital for Sick Children, University of Toronto, Canada.
Insights
Children undergoing liver transplantation (OLT) can often stop steroids, leading to improved growth. Successful steroid cessation after OLT promotes near-normal growth in pediatric patients with good graft function.
Area of Science:
- Pediatric Gastroenterology
- Transplantation Immunology
- Pediatric Endocrinology
Background:
- Liver transplantation (OLT) is standard for pediatric end-stage liver disease.
- Post-transplant growth remains a significant concern in children.
Purpose of the Study:
- Evaluate steroid cessation success rates post-OLT.
- Examine the impact of OLT on pediatric growth.
- Assess the effect of steroid reduction on growth.
- Quantify rejection risk during steroid withdrawal.
Main Methods:
- Retrospective review of 83 pediatric OLT patients surviving at least 1 year.
- Analysis of growth parameters (height, height velocity) and steroid dosage.
- Comparison of outcomes based on age and steroid status.
Main Results:
- Younger children (<5 years) weaned off steroids more effectively.
- Significant improvement in height and weight percentiles post-OLT.
- Inverse correlation between steroid dose and growth parameters.
- 60% of patients successfully discontinued steroids, achieving near-normal growth distributions.
- No graft loss due to rejection in steroid-free patients.
Conclusions:
- Majority of children can be weaned off steroids post-OLT.
- Steroid cessation, with good graft function, facilitates near-normal growth in pediatric OLT recipients.
- Steroid withdrawal is safe regarding graft rejection.
Abstract:
Although liver transplantation (OLT) has become standard therapy for end-stage liver disease in children, growth after OLT remains an area of concern. We reviewed our experience with growth after OLT at the Hospital for Sick Children in 83 patients who survived at least 1 yr post-transplant. Our aims were to describe the success rate in steroid cessation in patients after transplantation, to examine the effect of transplantation on subsequent growth, to see if steroid reduction had a beneficial effect on growth, and to quantify the risk of stopping steroids on rejection. Patients below age 5 yr were weaned off steroids more easily than those over age 5: 19.2% vs. 0% (p<0.05), 65.9% vs. 50%, and 79.5% vs. 37.5% (p<0.05) at post-transplant years 1, 2, and 3, respectively. Pre-transplant, 30% of patients were below the third percentiles for height and weight. Post-transplant, there was a steady improvement in the distribution of patients above the 3rd percentile, so that by post-transplant year 6, only 5% were below the 3rd percentile. Height and height velocity percentiles were found to correlate inversely with total yearly steroid dose (mg/kg) at post-transplant years 2, 3 and 6 (p<0.05). In 60% of patients, steroids were successfully discontinued. In these patients, height and height velocity percentiles have achieved a near normal distribution with 40% and 46% of patients above the 50th percentile for height and height velocity percentiles, respectively. No grafts were lost to rejection in those off steroids, and all rejection episodes were easily reversed. We conclude that the majority of children can be weaned off steroids successfully after OLT and that growth in those children in the presence of good graft function is near normal.