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Published on: May 24, 2024
Long-term Follow-up After Pediatric Liver Transplantation: Predictors of Growth
Nathalie Loeb1, Jillian S Owens1, Michele Strom1
1Research Institute.
Insights
Pediatric liver transplant recipients experience significant catch-up growth within two years, then growth plateaus. Early height z-score is the key predictor for long-term growth after liver transplantation.
Area of Science:
- Pediatric Gastroenterology
- Transplant Surgery
- Growth and Development
Background:
- Liver transplantation is a life-saving procedure for children with end-stage liver disease.
- Understanding long-term growth patterns post-transplantation is crucial for patient management and outcomes.
Purpose of the Study:
- To describe long-term growth trajectories in children following liver transplantation.
- To identify factors predicting post-transplantation growth in pediatric liver transplant recipients.
Main Methods:
- Retrospective cohort study of 127 children undergoing liver transplantation (1999-2008).
- Analysis of height and weight z-scores up to 10 years post-transplantation.
- Bivariate and multivariate Cox proportional hazards analyses to identify growth predictors.
Main Results:
- Mean height z-score improved significantly from -2.21 at transplant to -0.66 by year two.
- Growth stabilized after two years, with no significant increases observed up to year 10.
- Pre-transplant height z-score was the most significant predictor of linear growth post-transplantation.
Conclusions:
- Pediatric liver transplant recipients exhibit catch-up growth in the first two years, followed by a plateau.
- Optimizing growth in pediatric liver transplant patients requires attention to pre-transplant factors.
Objectives:
The aim of the study was to describe long-term growth postpediatric liver transplantation and to conduct bivariate and multivariate analysis of factors that may predict post-transplantation growth in children who received a liver transplant from January 1999 to December 2008 at the Hospital for Sick Children.
Methods:
A retrospective cohort study was conducted with follow-up of up-to 10 years post-transplantation. Mean height and weight z scores and annual differences in mean z scores were plotted against time after transplantation. A 1-way analysis of variance was conducted. Multivariate and univariate Cox proportional hazards analyses were conducted to determine factors associated with reaching the 50th and 25th percentiles for height.
Results:
A total of 127 children met eligibility criteria. The mean height z score at time of transplantation was -2.21 which by the second year post-transplantation increased significantly to -0.66 (mean increase of 1.55 standard deviation units). There were no further significant increases in mean height z score from 2 years post-transplantation until the end of follow-up at year 10. In multivariate analysis, height at transplant was the most important predictor of linear growth post-transplantation.
Conclusions:
Children who underwent liver transplantation had significant catch-up growth in the first 2 years post-transplantation followed by a plateau phase. Increased height z-score at transplantation is the most important predictor of long-term growth.
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