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Growth and height in children after liver transplantation
Insights
Linear growth in children after liver transplantation improves over time, normalizing by the second year. However, long-term short stature remains common due to various factors including steroid therapy.
Area of Science:
- Pediatric Endocrinology
- Hepatology
- Transplantation Medicine
Background:
- Liver transplantation in children can impact linear growth.
- Steroid immunosuppression, particularly prednisolone, is a key factor affecting growth post-transplant.
Purpose of the Study:
- To evaluate linear growth patterns in children following liver transplantation.
- To identify factors influencing growth, including steroid dosage and administration schedules.
Main Methods:
- Construction of height curves for 45 pediatric liver transplant recipients followed for over 2 years.
- Analysis of growth rates during daily and alternate-day prednisolone therapy.
- Correlation of growth rates with prednisolone dosage and underlying liver disease.
Main Results:
- Severe growth impairment occurred during daily steroid therapy, with normalization in the second year post-transplant.
- Fluctuating growth rates were observed even with alternate-day steroid regimens.
- Short stature was prevalent long-term, influenced by pre-transplant disease, steroid exposure, and pubertal delay.
Conclusions:
- Linear growth shows significant improvement in the second year after liver transplantation, but long-term short stature remains a concern.
- Alternate-day steroid therapy may lead to inconsistent growth rates.
- A multifactorial approach is needed to address short stature in pediatric liver transplant survivors.
Abstract:
To assess the linear growth after liver transplantation, height curves were constructed for 45 children who underwent liver transplantation at the Children's Hospital "La Paz", Madrid, and were followed for more than 2 years. The prednisolone dose was progressively tapered and switched to alternate-day administration at 12 months. Growth was severely impaired during daily steroid therapy but the mean growth rate normalized in the second year and a significant improvement was observed in successive years. Observations over a long period revealed fluctuating growth rates under stable or decreasing doses of prednisolone on alternate-day administration. Beyond the first year, some annual periods of abnormal growth rate occurred in 57% of the children. Marginally better posttransplantation growth was observed in children transplanted for intrahepatic cholestatic diseases. The prednisolone dose did not correlate with growth rate. In the long term, short stature was highly prevalent due to an accumulation of factors: previous disease, daily prednisolone period, inconstant growth rate under alternate-day steroid therapy, and pubertal delay.