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Effect of Preoperative Growth Status on Clinical Outcomes After Living-Donor Liver Transplantation in Infants
1Department of Liver Surgery, Ren Ji Hospital School of Medicine, Shanghai Jiao Tong University.
Insights
Preoperative growth status does not affect outcomes in infants undergoing living-donor liver transplantation (LDLT). Post-transplant, children experienced significant catch-up growth, particularly those with prior growth impairment.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Infantile liver disease, such as biliary atresia, often leads to severe growth impairment.
- Living-donor liver transplantation (LDLT) is a critical treatment for infants with end-stage liver disease.
- The impact of preoperative growth status on post-transplant outcomes in pediatric LDLT remains an important clinical question.
Purpose of the Study:
- To evaluate the effect of preoperative growth status on clinical outcomes in infants undergoing LDLT.
- To assess the influence of preoperative growth on liver function, complications, and survival after LDLT.
- To investigate the catch-up growth potential in infants following LDLT.
Main Methods:
- A retrospective study of 131 infants (≤1 year) undergoing LDLT between 2009 and 2014.
- Patients were categorized into abnormal growth (weight z-score <-2) and normal growth groups.
- Multivariate case-matched analysis (1:1) was used to compare 31 patients in each group regarding demographics, liver function, complications, and survival.
Main Results:
- Pre-transplant, the abnormal growth group had significantly lower weight, height, and BMI.
- Post-LDLT, liver function tests, early complications, and patient/graft survival rates (5-year: 90.2% vs 96.8%) were similar between groups.
- Significant catch-up growth was observed in both groups, especially in those with more severe preoperative growth retardation, with height and weight z-scores normalizing within 18 and 6 months, respectively.
Conclusions:
- Preoperative growth status does not impact liver function recovery, postoperative complications, or survival after infantile LDLT.
- LDLT effectively promotes catch-up growth in infants, particularly those with significant preoperative growth impairment.
- Infants with biliary atresia benefit from LDLT, achieving substantial growth normalization post-transplantation.
Objective:
The aim of this study was to evaluate the impact of preoperative growth status on clinical outcomes of infantile living-donor liver transplantation (LDLT).
Methods:
From January 2009 to December 2014, 131 LDLT recipients ≤1 year of age met the eligibility criteria of this study, of whom 31 patients with weight z-scores less than -2 constituted the abnormal growth group. Patients in the abnormal growth group were randomly matched (1:1) to patients with normal growth status by means of a multivariate case-matched method, and thus 31 patients in the normal growth group and 31 patients in the abnormal growth group were finally enrolled into the study. We compared the 2 groups regarding demographic characteristics, liver functions, postoperative complications, survival outcomes, and effects of catch-up growth.
Results:
Baseline characteristics were well matched between the 2 groups except that patients from the abnormal growth group were significantly inferior in terms of body weight (7.5 kg vs 6.0 kg; P < .01), height (65 cm vs 63 cm; P < .01), and body mass index (17.0 kg/m2 vs 14.8 kg/m2; P < .01) before LT. After LT, alanine transaminase, aspartate transaminase, alkaline phosphatase, γ-glutamyltransferase, albumin, and total bilirubin were all similar between the 2 groups. We also did not identify significant difference in any specific early complications or patient and graft survival rates (5-year: 90.2% vs 96.8%; P = .313). However, LT brought forth notable catch-up growth in both groups, especially for children with more serious growth retardation before LT. Differences of height z-scores between the 2 groups gradually diminished and lost significance 18 months after LT, and body weight z-scores between the 2 groups became similar 6 months after LT.
Conclusions:
Preoperative growth status had no impact on liver function recovery, postoperative complications, or survival outcomes after infantile LDLT. Although biliary atresia caused severe growth impairment in infants, LT brought forth notable catch-up growth, especially for children with more serious growth retardation before LT.
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