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Bone Mineral Density and Growth in Children Having Undergone Liver Transplantation With Corticosteroid-Free
Diana Mager1,2, Abeer Salman Al-Zaben1, Cheri Robert2
11 Department of Agriculture, Food, and Nutritional Sciences, University of Alberta, Edmonton, Canada.
Insights
Corticosteroid (CS) therapy after pediatric liver transplantation (LTX) is linked to poor growth and bone density. A CS-free LTX regimen may improve height z scores in children post-LTX.
Area of Science:
- Pediatric gastroenterology
- Hepatology
- Pediatric endocrinology
Background:
- Children undergoing liver transplantation (LTX) face risks of growth delay and reduced bone mineral density (BMD).
- Corticosteroid (CS) therapy and nutrient deficiencies are key contributors to these complications.
- A CS-free LTX protocol was implemented in 2003 to mitigate these adverse effects.
Purpose of the Study:
- To evaluate the impact of a CS-free LTX protocol on BMD and growth in children.
- To compare growth and bone health outcomes between children on CS therapy and those on a CS-free regimen post-LTX.
Main Methods:
- Retrospective chart review of pediatric LTX patients.
- Analysis of anthropometric data (weight, height z scores), BMD, bone mineral content (BMC), and CS dosage.
- Comparison of outcomes between CS and CS-free groups.
Main Results:
- Children on the CS-free protocol showed significantly improved height z scores compared to the CS group (P = .002).
- While not statistically significant, a trend towards better weight z scores was observed in the CS-free group (P = .09).
- Lumbar BMC and BMD did not differ significantly between groups, but both were inversely related to CS dose and positively related to bone age.
Conclusions:
- Corticosteroid therapy in children post-LTX is associated with impaired linear growth and reduced bone mineral content.
- The CS-free LTX protocol shows promise in improving growth outcomes.
- Further research into clinical and nutritional factors is crucial for optimizing bone health in pediatric LTX recipients.
Background:
Children post-liver transplantation (post-LTX) are at risk of growth delay and decreased bone mineral density (BMD) secondary to corticosteroid (CS) therapy and suboptimal intake of nutrients important for bone health. The pediatric LTX program at Stollery Children's Hospital introduced a CS-free LTX regimen in 2003. This retrospective study investigated whether the implementation of a CS-free protocol resulted in improvements in BMD (dual x-ray absorptiometry) and growth following LTX.
Methods:
A retrospective chart review of all children undergoing LTX was conducted. The parameters included repeated measures of anthropometric (weight, weight z score, height, height z score), BMD/bone mineral content (BMC), laboratory variables, graft function (number/severity of rejection), and CS therapy (dose, duration).
Results:
A total of 39 patients met study inclusion (20 male; n = 28 on CS; n = 11 CS-free). Mean duration of follow-up was 5.5 ± 3.3 years. The mean weight and height z scores were -0.31 ± 0.14 (CS) and 0.22 ± 0.23 (CS-free; P = .09) and -0.71 ± 0.13 (CS) and 0.23 ± 0.22 (CS-free; P = .002), respectively. Lumbar and whole-body BMD z score less than -2 were present in 15% and 8% of the cohort, respectively. There were no significant differences between CS and CS-free in lumbar BMC (22.2 ± 1.4 and 23.4 ± 2.02 g; P = .165) and lumbar BMD (0.57 ± 0.02 and 0.80 ± 0.22 g/cm2; P = .152), respectively. Lumbar BMC ( r2 = 0.89, P < .05) and whole-body BMC ( r2 = 0.93, P < .05) were inversely related to CS dose >0.2 mg/kg/d and positively related to bone age ( P < .01).
Conclusion:
CS therapy in children post-LTX is associated with reduced BMC and delayed linear growth. Understanding the clinical and nutrition factors influencing bone health is important to optimizing growth and bone health in children post-LTX.
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