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Linear growth after pediatric liver transplantation
S M Bartosh1, S E Thomas, M M Sutton
1Department of Pediatrics, Section of Pediatric Nephrology, The University of Wisconsin Medical School, Madison, USA.
Insights
Many children experience growth retardation before liver transplantation. Post-transplant, up to half show catch-up growth, especially younger patients with severe pre-transplant growth issues.
Area of Science:
- Pediatric Gastroenterology
- Transplantation Medicine
- Growth and Development
Background:
- Liver transplantation is a life-saving procedure for children with end-stage liver disease.
- Pre-transplant growth retardation is a significant concern in pediatric liver transplant recipients.
- Understanding post-transplant growth patterns is crucial for optimizing patient outcomes.
Purpose of the Study:
- To analyze growth patterns in a large cohort of children following liver transplantation.
- To identify factors influencing growth before and after liver transplantation.
- To assess the prevalence and predictors of catch-up growth post-transplant.
Main Methods:
- Retrospective review of 294 liver transplantations in 221 children (1984-1992).
- Analysis of height z-scores and growth velocity pre- and post-transplantation.
- Comparison of growth parameters based on age, underlying liver disease, and transplant characteristics.
Main Results:
- 39% of children had height z-scores < -2.0 at transplantation, with younger children being more affected.
- Biliary atresia was associated with poorer pre-transplant growth compared to other liver diseases.
- Catch-up growth (growth velocity z-score >0) was observed in 37%-47% of children post-transplant.
- Younger age at transplantation and greater pre-transplant growth retardation predicted better catch-up growth.
- Higher corticosteroid doses at 2 years post-transplant correlated with poorer growth.
Conclusions:
- A significant proportion of children exhibit growth retardation prior to liver transplantation.
- Liver transplantation offers potential for catch-up growth, particularly in younger recipients with severe pre-transplant growth deficits.
- Optimizing immunosuppression and monitoring growth are essential for improving long-term outcomes in pediatric liver transplant recipients.
Abstract:
To determine growth patterns in a large cohort of unselected children undergoing liver transplantation, the outcomes of 294 orthotopic liver transplantations performed in 221 children at The University of Chicago between October 1984 and October 1992 were retrospectively reviewed; 66% were alive at the time of this analysis. The mean age at transplantation was 4.1 +/- 5.0 years; 44% of the children were male and 16% of the transplants were from living-related donors. The mean height z score at the time of transplantation was -1.6 +/- 1.8, and 39% of children had height z scores of < -2.0 at transplantation. When children with growth retardation at the time of transplantation (height z scores of < -2. 0) were compared with children with more normal growth, there were no significant differences in gender or re-transplantation rates, although children with growth retardation at transplantation were significantly younger than those with more appropriate growth (2.8 +/- 4.1 years vs 4.7 +/- 5.1 years, P <.05). The height z score of all children with biliary atresia at the time of transplantation was -1.9 +/- 1.7 compared with -1.2 +/- 2.0 in those children with underlying diseases other than biliary atresia. Catch-up growth was seen in 37% to 47% of children at any given time point after transplantation. Children with evidence of catch-up growth (growth velocity z score >0) 2 years after transplantation were more likely to be first-time transplant recipients, had more growth retardation at the time of transplantation, and were receiving lower doses of prednisone at 2 years after transplantation. Younger children were most likely to demonstrate catch-up growth after transplantation. In summary, a large proportion of children have growth retardation at the time of liver transplantation. This growth retardation is inversely correlated with age. Before transplantation, children with biliary atresia grow less well than children with other forms of liver disease. Up to one half of children demonstrate catch-up growth after liver transplantation. Growth after transplantation is proportional to the degree of growth retardation at transplantation and inversely correlated to age at transplantation. Children with poor growth after transplantation are more likely to be receiving higher doses of corticosteroid.