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Analysis of growth in children after orthotopic liver transplantation
P M Peeters1, E Sieders, E M ten Vergert
1Liver Transplant Group University Hospital Groningen, The Netherlands.
Insights
Pediatric liver transplant recipients experience continuous growth without catch-up. Early transplantation is crucial for children with end-stage liver disease, especially those with pre-existing growth issues.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Transplantation Medicine
Background:
- Growth is a critical determinant of quality of life in pediatric liver transplant recipients.
- Assessing growth patterns post-transplantation is essential for long-term patient outcomes.
Purpose of the Study:
- To evaluate the influence of primary diagnosis, liver function, and immunosuppressive therapy on growth in pediatric liver transplant recipients.
- To analyze height and skeletal age progression after liver transplantation.
Main Methods:
- Collected data on height, skeletal age, and liver function in 45 pediatric liver transplant recipients.
- Plotted height and skeletal age standard deviation scores over time post-transplantation.
- Assessed the impact of primary diagnosis, liver function, and immunosuppression on growth parameters.
Main Results:
- Growth in height and skeletal age was continuous but lacked a 'catch-up' phenomenon.
- Poor liver function negatively affected both height and skeletal growth.
- Higher alternate-day prednisolone doses were associated with reduced skeletal growth.
Conclusions:
- Pre-transplant growth deficits are unlikely to be restored after pediatric liver transplantation.
- Early liver transplantation is recommended for children with end-stage liver disease, particularly those with impaired pre-transplant growth.
- Optimizing immunosuppressive regimens may be necessary to support growth post-transplantation.
Abstract:
Growth after pediatric liver transplantation is an important factor in determining the quality of life. We collected data on height, skeletal age, and liver function of 45 consecutive pediatric transplant recipients and assessed the influence of primary diagnosis, liver function, and immunosuppressive regimen on their growth. Height and skeletal age were plotted as median standard deviation scores versus years post-transplantation. Growth, in terms of both height and skeletal age, were continuous without catch-up growth. Primary diagnosis was found to have no influence on height and poor liver function had a negative effect on both height and skeletal growth. A higher alternate day prednisolone maintenance dose also had negative effect on skeletal growth. Thus, it can be concluded that a pretransplant lack of growth will not be restored and is an indication for early transplantation in end-stage liver disease, especially in younger children.