Growth curves of pediatric patients with biliary atresia following living donor liver transplantation: Factors that influence post‐transplantation growth

Abstract

We evaluated the growth curves of children with BA after LDLT, and identified factors influencing growth velocity one-yr after LDLT (DeltaZ). The clinical data of 51 children with BA, who had an LDLT at our center from 2001 to 2005, were retrospectively reviewed. The Z scores for height and weight, and DeltaZ were studied. The correlation between DeltaZ and various clinical factors was evaluated statistically. Multivariate stepwise analyses were performed for DeltaZ. The average height and weight Z scores at the time of LDLT were -1.34 +/- 1.36 (+/-s.d.) and -0.78 +/- 1.15, respectively. Among 30 BA recipients with stable liver function after transplant, weight returned to normal one-yr post-transplantation. However, height did not return to normal even by the third post-transplantation year. On multivariate analyses, 73% of the variance in height DeltaZ could be accounted for by factors such as standardized height at the time of LDLT (proportion of variance: 38%), number of steroid pulse treatments (17%), donor age (10%), and the presence of HVS (9%). Fifty-four percentage of the variance in weight DeltaZ could be accounted for by factors such as standardized weight at the time of LDLT (37%) and the total steroid dose given (17%). Height and weight status at the time of LDLT likely have the strongest impact on DeltaZ. Additional factors include steroid exposure, age of the living donor, and presence of HVS, all of which should be considered to improve post-transplantation growth.

Therapeutic Effectiveness of Nutrition Therapy in Pediatric Patients with Chronic Liver Diseases Awaiting Liver Transplantation

“…Furthermore, our data confirmed the greater effectiveness of intensive nutrition in shortening the length of hospital stay among females and younger patients, thus confirming the results of other studies (Renz et al, 2001;Bartosh, Thomas, Sutton, Brady, & Whitington;Saito et al, 2007). In some studies (Alonso, 2008;Bartosh et al, 1999;Saito et al, 2007), the mean height Z-score of the population waiting for liver transplantation ranged between -1.0 and -1.75.…”

“…It is known that exposure to steroids delays children's growth (Alonso, 2008;Saito et al, 2007). In fact, most current immunosuppression protocols do not envisage the use of steroids (Spada et al, 2006;Sarna, Sipila, Vihervuori, Koistinen, & Holmberg, 1995) except in cases of severe acute rejection or autoimmune hepatitis.…”

“…In some studies (Alonso, 2008;Bartosh et al, 1999;Saito et al, 2007), the mean height Z-score of the population waiting for liver transplantation ranged between -1.0 and -1.75. The mean height Z -score of the 34 children in our study, which was -1.30 ± 2.11 at admission, was within this range.…”

“…According to Bucuvalas et al (2004), infectious complications during the initial post-transplant period significantly affect the short and long term success of transplantation. Saito et al (2007) state that the complication that most affects the velocity of growth in height is hepatic vein stenosis, because it is difficult to arrive at an early diagnosis compared with other vascular stenoses and with biliary stenosis.…”

“…According to Saito et al (2007), children below the age of two years affected with biliary tract atresia tend to grow faster despite severe pre-transplant malnutrition. According to Renz (2001) who divided his study population into 3 groups, as had Tanner et al (1966), there are significant differences in terms of height Z-score and velocity of growth Z-score in the posttransplant period.…”