Linear growth after pediatric liver transplantation

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.