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Growth and final height after liver transplantation during childhood
Rene Scheenstra1, Willem Jan Gerver, Roelof J Odink
1Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands. r.scheenstra@bkk.umcg.nl
Insights
Pediatric liver transplantation (LTx) improves growth in children with end-stage liver disease, but final height remains a concern. Children with cholestatic liver disease show better catch-up growth post-transplant.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Transplantation Medicine
- Growth and Development
Background:
- End-stage pediatric liver disease frequently causes significant growth retardation.
- Children with cholestatic liver disease often experience more severe pre-transplant growth deficits.
Purpose of the Study:
- To assess the impact of pediatric liver transplantation (LTx) on growth and final height.
- To identify factors influencing growth outcomes after LTx in children.
Main Methods:
- Evaluated growth at 2 and 5 years post-LTx in 101 and 63 children, respectively.
- Assessed final height in 23 children who reached maturity.
- Expressed height as a standard deviation score relative to target height (zTH score).
Main Results:
- A significant increase in zTH score was observed within 2 years post-LTx (from -1.7 to -1.3 SD).
- Catch-up growth post-LTx correlated positively with pre-transplant growth retardation.
- Children with cholestatic liver disease showed more severe pre-LTx growth retardation but better 2-year growth post-LTx compared to non-cholestatic cases.
Conclusions:
- Growth retardation is prevalent in pediatric liver disease patients, especially those with cholestatic conditions.
- Post-LTx catch-up growth is partial, with significant benefits noted in severely growth-retarded cholestatic children.
- Approximately 50% of children undergoing LTx achieve a final height below -1.3 SD of their target height.
Objective:
To evaluate the effect of end-stage pediatric liver disease and liver transplantation on growth and final height.
Patients And Methods:
We evaluated growth at 2 years (n = 101) and 5 years (n = 63) after pediatric liver transplantation (LTx). Twenty-three children reached final height. Height was expressed as a standard deviation score of the target height (zTH score) of each patient.
Results:
At the first 2 years after LTx, the zTH score was significantly increased from -1.7 to -1.3 SD (P < 0.05). Growth at 2 or 5 years after LTx, expressed as DeltazTH score, was positively correlated with pretransplant growth retardation (P < 0.05). In comparison with patients with noncholestatic primary liver disease, patients with cholestatic primary liver disease were more severely growth retarded before LTx (zTH score -2.0 vs -1.2 SD, P < 0.05) and had better growth in the first 2 years after LTx (DeltazTH score +0.6 vs -0.1 SD, P < 0.05). Twelve of the 23 patients had a final height below -1.3 SD of their target height.
Conclusions:
Growth retardation is common in children before LTx, particularly in children with an underlying cholestatic disease. After LTx, catch-up growth was partial and was prominent only in cholestatic children who had been severely growth retarded before LTx. After LTx during childhood, approximately 50% of patients reach a final height lower than -1.3 SD of their genetic potential.
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