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Author Spotlight: Evaluating Therapeutic Strategies to Enhance Liver Regeneration
Published on: May 24, 2024
Low-dose steroids do make a difference: Independent risk factors for impaired linear growth after pediatric liver
Christoph Leiskau1,2, Saskia Samuel1,2,3, Eva-Doreen Pfister1
1Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
Insights
Pediatric liver transplant recipients experience growth failure, but catch-up growth occurs post-transplant. Pre-existing growth issues and low-dose steroids are key risk factors impacting long-term height development.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Transplantation Immunology
- Pediatric Endocrinology
Background:
- Growth failure is a significant complication following pediatric liver transplantation, impacting long-term development and quality of life.
- While steroid dose minimization aims to prevent growth impairment, long-term data in pediatric liver recipients remains limited.
- Understanding risk factors for impaired linear growth is crucial for optimizing post-transplant care.
Purpose of the Study:
- To identify risk factors for impaired linear growth in pediatric liver recipients up to five years post-transplantation.
- To specifically evaluate the impact of low-dose steroid therapy on long-term growth outcomes.
- To analyze the influence of pre-transplant factors, graft-related issues, and peri-transplant variables on growth trajectory.
Main Methods:
- Single-center retrospective analysis of height development in pediatric liver recipients.
- Inclusion of patients up to five years post-transplantation.
- Univariate and multivariate logistic regression to identify risk factors for impaired linear growth (height Z-scores ≤ -2).
Main Results:
- At transplantation, 52.2% of recipients exhibited growth retardation, primarily younger children.
- Height Z-scores significantly improved from -2.23 at baseline to -1.40 at two years and -1.19 at five years post-transplant.
- Multivariate analysis identified previous growth impairment, graft loss, and prolonged cold ischemic time as significant long-term risk factors. Continuous low-dose steroid therapy was associated with impaired growth at two and five years.
Conclusions:
- Significant catch-up growth is observed after pediatric liver transplantation, but initial growth failure remains a concern, especially in younger recipients.
- Pre-existing growth failure is the main modifiable long-term risk factor, highlighting the need for early nutritional support.
- Low-dose steroid therapy may negatively impact growth and warrants critical evaluation in long-term immunosuppression strategies.
Abstract:
Growth failure persists after pediatric liver transplantation and impairs pediatric development and quality of life. Steroid dose minimization attempts to prevent growth impairment, yet long-term assessment in pediatric liver recipients is lacking. We identified risk factors for impaired linear growth after pediatric liver transplantation, with a special focus on low-dose steroid therapy. This is a single-center retrospective analysis of height development in pediatric liver recipients up to 5 years after transplantation. Risk factors for impaired linear growth (height Z-scores≤-2) at transplantation, after two (n = 347) and five years (n = 210) were identified by univariate and multivariate logistic regression. At transplantation, growth retardation was found in 52.2%, predominantly younger children. Height Z-scores improved from -2.23 to -1.40 (SE 0.11; 95%CI 0.74-1.16; p < .001) two years and -1.19 (SE 0.07;0.08-0.34; p = .017) five years post-transplant. Multivariate analysis showed previous growth impairment (OR=1.484; 95%-CI=1.107-1.988; p = .004), graft loss (49.006;2.232-1076; p = .006), and prolonged cold ischemic time (1.034;1.007-1.061; p = .011) as main long-term risk factors; steroid use was a significant predictor of 2-year but not 5-year growth impairment. In univariate analysis, impaired growth after 2 and 5 years was associated with continuous low-dose (2.5 mg/m2 BSA) steroid therapy (OR=3.323;1.578-6.996; p < .001/OR=8.352;1.089-64.07; p = .006)and graft loss (OR=2.513;1.395-4.525; p = .003/OR=3.378;1.815-7.576; p < .001). Furthermore, indication and era of transplantation affected growth. Our results show significant catch-up growth after pediatric liver transplantation, yet growth failure strongly affects particularly young liver recipients. The main influenceable long-term risk factor is pre-existing growth failure, emphasizing the importance of early aggressive nutritional therapy. Moreover, low-dose steroid therapy might impair growth and should therefore be critically questioned in long-term immunosuppression.
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