Can children catch-up growth after living-donor liver transplantation?

Abstract

Several studies have shown improved growth after liver transplantation, but long-term follow-up data have been lacking. This study was aimed at evaluating the ability of children to catch up in height after living donor liver transplantation (LDLT) and at clarifying factors affecting growth. Growth was assessed by serial height measurements performed during follow-up. Standardized height scores (z scores) were calculated for each patient preoperatively (at the baseline) and at 1, 2, 3, 5, 10, and 15 years after LDLT. The risk potential of several preoperative and postoperative variables was evaluated. A total of 237 patients, including 159 females (67.1%), met the inclusion criteria. The mean age at the time of transplant was 3.89 6 0.28 years. The mean z score was À1.70 6 0.09, whereas the baseline height deficit was À6.50 6 0.39 cm. After LDLT, the z score improved significantly and reached À0.64 6 0.14 by the end of the first year. The best height improvement was seen after 10 years (À0.33 6 0.16). However, significant growth retardation remained at 15 years (À0.47 6 0.17). Height showed 3 distinct phases after transplantation: a growth spurt, a plateau phase, and a late declining phase. Univariate and multivariate analyses showed that children under 2 years and those with the most growth retardation at the time of LDLT achieved the best height gain in the first year. Late growth retardation was related to the baseline z score, ABO-incompatible grafts, and graft dysfunction. In conclusion, children have the potential ability to catch up in growth to normal levels after LDLT; they can show impressive height gains in the first year followed by protracted improvement over 10 years and then late growth retardation. Young age is a determinant for early height gain, whereas ABO-incompatible grafts and graft dysfunction are determinants for late growth retardation. In contrast, the baseline z score is a determinant for both. Liver Transpl 16:453-460,

Neurocognitive outcomes at kindergarten entry after liver transplantation at <3 yr of age

“…Poor pretransplant growth has been linked to lower cognitive development . The literature on pretransplant and post‐transplant linear growth in children receiving a liver indicates a prolonged period of improved growth . In this study, we have been unable to show that length Z ‐scores were linked to neurocognitive outcomes.…”

Evaluation of Growth After Liver Transplantation in Turkish Children

“…The mean Z H score was -1.6, and 43.7% of patients had Z H score below -2SD in our study. Baseline Z H scores ranged from -1.2 to -1.7 and the percentage of patients below -2SD was 33-39% in previous studies [7,8,[13][14][15][16]. Even though the percentage of patients with cholestatic liver diseases (48.8%) was less in our study group compared with in other studies, our patient group had more growth retardation at time of LT, suggesting lack of nutritional support in these patients before referral to our transplantation center or while on the waiting list for LT at our center.…”

Four hundred thirty consecutive pediatric living donor liver transplants: Variables associated with posttransplant patient and graft survival

“…In the pretransplant scenario, malnutrition and hyperbilirubinemia are associated with an increased need for transplantation or death in patients with BA, even after Kasai portoenterostomy is performed 13. After transplantation, studies have shown that a pretransplant weight deficit is associated with late patient mortality (>1 year),14 and the baseline z score is related to late growth retardation15 as well as increased hospital stays and greater hospital costs 6. In this series, 40% of the patients were severely malnourished, and the univariate analysis demonstrated inferior patient and graft survival.…”