The aim of this retrospective analysis was to evaluate the growth of 96 pediatric liver transplant recipients from February 1988 to June 1999. Inclusion criteria were the following: age younger than 18 years, follow-up longer than 1 year, transplantation for a nontumor indication, and no retransplantation. Linear height and growth velocity SD scores were correlated to age, sex, indication for transplantation, immunosuppression, and graft type. Transplant recipients of all ages and indications and both sexes were growth retarded at transplantation. Recipients aged younger than 24 months showed growth within the first year to achieve a height distribution equal to that of an age-matched population. Posttransplantation growth inversely correlated with height standard score at transplantation. Children older than 2 years at transplantation established new growth curves, but remained growth retarded. As children approached the prepubertal growth acceleration, growth deficits frequently were erased. Transplant recipients with biliary atresia and ␣ 1 -antitrypsin deficiency showed increased growth performance compared with those who underwent transplantation for chronic hepatitis or fulminant hepatic failure. Boys were less growth retarded at transplantation and showed improved posttransplantation growth performance versus girls. No correlation to immunosuppression or graft type was identified. We conclude that early transplantation of children who show growth retardation is optimal for restoration of growth potential, whereas delaying transplantation in older children impedes potential growth. (Liver Transpl 2001;7:1040-1055.)

No abstract

Liver transplantation is accepted as the standard management for end-stage liver disease in children. Pediatric heart and heart-lung transplant recipients have shown significantly diminished exercise capacities compared with age-matched, able-bodied, control subjects. The primary aim of this study is to compare the fitness levels of a group of pediatric liver transplant (LT) recipients (LT group, 20 boys, 9 girls; age, 8.9 ؎ 4.8 years; 56 ؎ 35 months posttransplantation) with a group of able-bodied control subjects ( T ransplantation is the accepted therapy for endstage organ failure. Thirty five thousand individuals received organ transplants in 1998, and this number is growing. One of the major reasons for this increase over previous years is the better long-term prognosis for these individuals. 1 Common to all adult liver transplant (LT) candidates is an impaired physical performance level before transplantation. [2][3][4] It is expected that impaired exercise capacity affects the performance of adults in their daily recreational activities and inhibits the accomplishment of simple physical tasks. Although improved physical functioning is assumed after transplantation, limited information exists regarding the physical functioning of adult and pediatric transplant recipients. 2 The limited cross-sectional data that exist in pediatric heart, heart-lung, and lung transplant recipients showed significant (43% to 64%) reductions in physical work capacity compared with able-bodied control subjects. 5 The limitations to exercise performance more likely stem from central limitations in heart and heartlung transplant recipients and pretransplantation exercise intolerance. Both reduced exercise tolerance on a treadmill walking test 6 and reduced cardiorespiratory fitness (maximal oxygen consumption [VO 2 max]) on a cycle ergometer 7 compared with able-bodied control subjects have been shown in adolescent renal transplant recipients. Reductions in VO 2 max compared with agematched healthy individuals 8 and limitations in daily functioning were noted in adult LT recipients. [9][10][11] To the best of our knowledge, no research has been conducted on the assessment of fitness levels in pediatric LT recipients. The purpose of this study is to use simple field tests of the basic components of physical fitness (cardiorespiratory fitness and muscular endurance, specifically abdominal and flexibility) to (1) compare the fitness level of pediatric LT recipients with able-bodied control subjects and (2) assess the proportion of pediatric LT recipients capable of achieving able-bodied pediatric criterion fitness standards.

No abstract