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Effect of Muscle Mass on Catch-Up Growth After Liver Transplant in Infants With Biliary Atresia
María D Lledín1, Manuel Parrón-Pajares2, David Andrade-Guerrero3
1Department of Pediatric Hepatology & Liver Transplant, Hospital Universitario La Paz & IdiPAZ, Madrid, Spain.
Insights
Children with biliary atresia who underwent liver transplant showed initial growth stagnation. Lower muscle mass at transplant was linked to more significant catch-up growth in pediatric liver transplant recipients.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Transplant Surgery
Background:
- Loss of muscle mass (sarcopenia) is linked to short-term complications after pediatric liver transplantation for biliary atresia.
- Limited data exists on sarcopenia's impact on long-term growth outcomes in these children.
Purpose of the Study:
- To investigate the association between baseline muscle mass and long-term catch-up growth in children with biliary atresia following liver transplantation.
- To determine if sarcopenia influences growth trajectories post-liver transplant.
Main Methods:
- Retrospective analysis of 44 pediatric patients with biliary atresia undergoing liver transplant before 18 months of age.
- Baseline psoas muscle area measured via CT scan; height Z-scores tracked over time to define catch-up growth.
- Correlation and multivariate analyses performed to assess relationships between muscle mass and growth parameters.
Main Results:
- Patients experienced initial growth stagnation followed by significant catch-up growth between 6 and 24 months post-transplant.
- Lower baseline psoas muscle mass was negatively correlated with catch-up growth.
- Children in the lowest muscle mass tertile exhibited significantly more catch-up growth compared to those in the highest tertile.
Conclusions:
- Lower muscle mass at the time of liver transplantation is associated with more pronounced and sustained catch-up growth in pediatric patients with biliary atresia.
- Muscle mass is a significant predictor of catch-up growth post-liver transplant, independent of other clinical factors.
Background:
Loss of muscle mass is closely associated with short-term postliver transplant complications in children with biliary atresia. However, studies examining the impact of sarcopenia on long-term outcomes such as growth are very limited.
Methods:
A cohort of 44 patients with a diagnosis of biliary atresia who underwent liver transplant before 18 months of age. All patients had baseline abdominal CT scans with measurement of the psoas muscle area. Height was recorded at several time points, and catch-up growth was defined as the increase in height Z-score between two measurements.
Results:
During the first 6 months, patients exhibited growth stagnation, with a mean Δ height Z-score of -0.29 ± 0.91. Between 6 and 24 months, a marked catch-up growth occurred, with a Δ height Z-score of 0.62 ± 0.78. This was followed by a slower, gradual increase. Fifteen patients completed a 7-year follow-up, with a height Z-score of -0.52 ± 0.77. Psoas muscle mass was negatively correlated with catch-up growth from transplantation to 2 years after (r = -0.307, p = 0.043), and also from the 6-month nadir to 4 years after (r = -0.392, p = 0.016). When stratified into muscle mass tertiles, the lowest one showed significantly more catch-up growth compared to the highest one (p = 0.037). Baseline height Z-score, age at the time of transplantation, pediatric end-stage liver disease score, and the accumulated corticoid doses from 6 to 12 months showed significant correlations with the catch-up growth, but only muscle mass remained significant after multivariate analysis.
Conclusions:
Children with lower muscle mass at the time of liver transplant demonstrated more pronounced and sustained catch-up growth.
