Growth of long-term survivors of liver transplantation

Area of Science:

• Pediatric Gastroenterology
• Transplant Surgery
• Endocrinology

Background:

• Liver transplantation is a life-saving procedure for children with end-stage liver disease.
• Assessing long-term growth and pubertal development is crucial for survivors' quality of life.

Purpose of the Study:

• To evaluate the growth trajectory and final height outcomes in pediatric liver transplant recipients.
• To identify factors influencing growth and pubertal development post-transplantation.

Main Methods:

• A longitudinal study followed 105 children up to seven years post-liver transplantation.
• Growth parameters, including height standard deviation score (zH), were monitored.
• Factors such as age at transplantation, diagnosis, steroid dosage, and liver function were analyzed.

Main Results:

• Mean height standard deviation score (zH) improved from -1.22 at transplantation to -0.55 at final height.
• Significant catch-up growth and pubertal development were observed over five years post-transplant.
• Early growth and pubertal retardation were noted in the first six months, with recovery thereafter.
• Initial zH, bilirubin levels, and prednisolone dose predicted short-term growth.
• Long-term growth was predicted by initial zH and cumulative prednisolone dose.

Conclusions:

• Pediatric liver transplant recipients can achieve near-normal final height, especially when transplanted earlier.
• Early growth and pubertal delays are often transient, with most patients resuming appropriate development.
• Factors like high steroid doses, poor liver function, and retransplantation are associated with poorer height outcomes.
• Severe short stature at final height is primarily seen in those with pre-existing severe growth retardation at transplantation.