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Linear growth patterns in prepubertal children following liver transplantation

E M Alonso1, R Shepherd, K L Martz

  • 1Children's Memorial Hospital, Pediatrics, Chicago, IL, USA. e-alonso@northwestern.edu

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|May 23, 2009
PubMed

Insights

Pediatric liver transplant recipients often experience impaired linear growth. Metabolic disease and prolonged steroid use increase this risk, while higher pre-transplant weight and height percentiles offer protection.

Area of Science:

  • Pediatric Gastroenterology and Hepatology
  • Transplantation Medicine
  • Growth and Development

Background:

  • Linear growth following pediatric liver transplantation (LT) is not fully understood.
  • Identifying factors influencing growth is crucial for improving outcomes in young transplant recipients.

Purpose of the Study:

  • To examine predictors of linear growth impairment in prepubertal children undergoing liver transplantation.
  • To analyze factors associated with catch-up growth post-transplantation.

Main Methods:

  • Longitudinal analysis of 1143 children from the Studies of Pediatric Liver Transplantation with serial height measurements.
  • Multivariate analysis to identify risk factors for growth impairment and predictors of catch-up growth.

Main Results:

  • Mean height scores improved post-LT but remained below normal, with limited catch-up growth observed up to 60 months.
  • 33.8% of patients were below the 10th percentile for height at 24 months post-LT.
  • Metabolic disease (OR 4.4) and >18 months of steroid exposure (OR 3.02) were associated with increased risk of growth impairment. Higher pre-LT weight and height percentiles decreased this risk.

Conclusions:

  • Linear growth impairment and incomplete catch-up growth are common after pediatric LT.
  • Minimizing steroid exposure and addressing pre-LT growth failure may improve outcomes.
  • Metabolic disease, prolonged steroid use, and certain cholestatic diseases negatively impact catch-up growth.

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