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Growth in children with biliary atresia before and after liver transplantation: a retrospective analysis
Ye Wang1, Pingping Zhang1, Ji Qi1
1Department of Paediatrics, Tianjin First Central Hospital, Tianjin, China.
Insights
Children with biliary atresia (BA) experience growth delays before liver transplantation. Post-transplant, catch-up growth occurs, especially in those with severe preoperative delays, with biliary complications impacting recovery.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Biliary atresia (BA) is a leading cause of pediatric liver disease requiring transplantation.
- Long-term growth and survival outcomes post-liver transplantation for BA in China remain understudied.
- Understanding factors influencing post-transplant growth is crucial for improving pediatric outcomes.
Purpose of the Study:
- To investigate long-term survival and growth status in children with BA post-liver transplantation in China.
- To identify specific factors affecting growth and survival after liver transplantation for BA.
- To evaluate the impact of preoperative growth on postoperative recovery and complications.
Main Methods:
- Retrospective analysis of 93 children under 2 years old who underwent liver transplantation for BA.
- Collection of clinical data, liver function indicators, growth parameters, and ascites status.
- Systematic assessment of postoperative complications using the Clavien-Dindo classification system.
Main Results:
- Significant catch-up growth in height-for-age Z-score by year 2 post-transplantation (P=0.001).
- Preoperative growth delay negatively correlated with 2- and 5-year growth improvement (P<0.001).
- Biliary complications significantly associated with impaired catch-up growth (P=0.008); weight-for-age Z-score improved significantly in the first two years.
Conclusions:
- Growth retardation is common in pediatric BA patients before liver transplantation.
- Catch-up growth begins six months post-transplantation, peaking after two years.
- Preoperative growth status has minimal impact on early liver function recovery but influences long-term growth trajectory.
Background:
Little is known about the long-term survival and growth outcomes of children following liver transplantation in China. Therefore, we investigated the long-term survival and growth status of children with biliary atresia (BA) before and after liver transplantation and attempted to identify specific influencing factors.
Methods:
We included children who underwent liver transplantation for BA at Tianjin First Central Hospital between January 2014 and December 2018. Clinical data, indicators of liver function, growth data, and ascites status were collected for analysis from all patients. Postoperative complications were systematically assessed using a combination of clinical, laboratory, histological, and imaging evaluations. Complications were categorized and graded according to the Clavien-Dindo classification system.
Results:
This study included a total of 93 children under 2 years of age who underwent liver transplantation for BA. No significant increase in height was observed six months post-transplantation when compared to pre-transplantation (P = 0.126). A significant increase in the height-for-age Z-score occurred by year 2 (P = 0.001). Preoperative growth was negatively correlated with growth improvement at 2- and 5-years after transplantation (P < 0.001, r = -0.674 and r = -0.774, respectively). The occurrence of biliary complications was significantly associated with impaired catch-up growth post-transplantation (P = 0.008). The weight-for-age Z-score increased significantly over the first two years post-transplantation when compared with that before transplantation (P < 0.001); subsequently, this parameter plateaued and exhibited only minimal changes.
Conclusions:
Growth retardation is common in children with BA prior to liver transplantation, with catch-up growth commencing six months post-surgery and peaking after two years. Children with more severe preoperative growth delays exhibited faster postoperative growth. Preoperative growth status exhibited only minimal impact on early liver function recovery post-transplantation.
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