Effect of orthotopic liver transplantation on bone mineral content and serum vitamin D metabolites in infants and children with chronic cholestasis

Argào, Eric A.; Balistreri, William F.; Hollis, Bruce W.; Ryckman, Frederick C.; Heubi, James E.

doi:10.1002/hep.1840200308

Cited by 48 publications

(23 citation statements)

References 25 publications

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“…Our center has shown previously that in a small group of patients with biliary atresia, BMD normalizes at 1 year after transplantation. 10 We have observed also that children with cholestatic liver disease have progressively worsening BMD z-scores with increasing age, which suggests that their bone mass may be reduced to a similar extent as adults when they come to transplantation when compared with age-and sex-matched controls. 14 Given the low prevalence of reduced bone mass in this study sample and the likelihood that bone mass was markedly reduced at the time of transplant, we speculate that BMD can normalize in patients undergoing transplantation in childhood.…”

Section: Discussionmentioning

confidence: 60%

“…Children actively accrete bone during the first 2 decades of life. The decreased BMD associated with liver disease 10 and subsequent transplant 7 merely interrupt, but do not halt, bone accretion. Thus, children and adults may have bone resorption and remodeling after transplantation.…”

Section: Discussionmentioning

confidence: 98%

“…However, this finding is not surprising because the association between decreased BMD and glucocorticoids is well described. Moreover, longitudinal studies in children have shown that BMD normalizes approximately 1 year after transplantation, 10 and Porayko et al 7 have shown that BMD changes with time after transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…In a small group of infants with cholestasis, Argao et al 10 showed that BMD improved after liver transplantation and normalized after a mean follow-up of 11.2 months. This study used older techniques and included a highly selected patient population.…”

mentioning

confidence: 99%

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Bone mineral density in long-term survivors following pediatric liver transplantation

Guthery

Pohl

Bucuvalas

et al. 2003

Liver Transplantation

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We sought to estimate the prevalence of reduced bone mass, defined by lumbar spine bone mineral density (LS-BMD) (z-score < ؊2.0), and to determine the factors associated with LS-BMD after liver transplantation in children and adolescents. LS-BMD z-scores were measured in a sample of subjects who had undergone liver transplantation in childhood or adolescence using dual energy x-ray absorptiometry (DXA). One hundred nine patients underwent DXA. The mean age at transplantation was 4.3 years (median, 1.8 years), and mean duration since transplantation was 6.2 years (median, 5.8 years). The mean weight z-score was ؊0.130 (SD, 1.26). The mean LS-BMD z-score was ؊0.243 (SD, 1.27). Eight patients, or 7.3% (95% confidence interval [CI], 2.4% to 12.2%), had reduced bone mass. Compared with those without reduced bone mass, subjects with reduced bone mass were more likely to have been treated for rejection at least once (87.5% versus 51.5%; P ‫؍‬ .07), and had greater cumulative exposure to prednisone during the year before DXA (92.3 versus 26.2 mg/kg/y; P ‫؍‬ .001). Multiple linear regression determined that LS-BMD z-score was positively associated with time since transplantation and weight z-score and negatively associated with cumulative prednisone exposure. Serum 25-OH vitamin D was measured and reduced (< 15 ng/mL) in 5 of 87 patients, one of whom had reduced bone mass. In conclusion, the prevalence of reduced bone mass was 7.3% in our population. Only certain patients appear to be at risk for low BMD, including those with a history of rejection. Screening for reduced bone mass may be appropriate for these patients. (Liver Transpl 2003;9:365-370.) C hildren under the age of 18 years account for approximately 12% of all liver transplantation recipients. 1 Although the number of new recipients will likely remain the same, the number of children living with a graft continues to increase. Thus, the number of survivors outnumber the number of new recipients by approximately 10-fold. 1 Consequently, determining the prevalence of the long-term complications of liver transplantation is critical to understanding the longterm needs of this unique patient population.Decreased bone mineral density (BMD) has been reported to occur in adults after liver transplantation. [2][3][4][5][6][7][8][9] Longitudinal studies have shown improvement but not normalization of BMD after liver transplantation. 2,3,5,9 Bone accretion occurs during the first 3 decades of life, peaking late in the second decade for women and early in the third decade in men. Because liver transplantation in children occurs before attainment of peak bone mass, the prevalence of decreased BMD may be quite different in children.In a small group of infants with cholestasis, Argao et al 10 showed that BMD improved after liver transplantation and normalized after a mean follow-up of 11.2 months. This study used older techniques and included a highly selected patient population.There are no large studies reporting the prevalence of low BMD in children after liver transplan...

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Bone mineral density in long-term survivors following pediatric liver transplantation

Guthery

Pohl

Bucuvalas

et al. 2003

Liver Transplantation

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“…In infants and children younger than 2 years with chronic cholestasis, the bone mineral content normalizes approximately 11 months after orthotopic liver transplantation. This normalization was preceded by a sustained period of normal serum 25-OH-D levels [45] .…”

Section: Vitamin D Deficiencymentioning

confidence: 99%

Nutritional Management of Cholestatic Syndromes in Childhood

Socha¹

2008

Ann Nestlé [Engl]

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Cholestatic liver disease causes severe risk of malnutrition which includes protein-energy malnutrition and specific nutritional deficiencies. The nutritional status can be assessed based on anthropometric measurements, which can be misleading because of ascitis and peripheral edema. Biochemical determinations of lipid-soluble vitamin status are important to evaluate requirements. Based on nutritional status assessment, nutritional therapy should be planned according to a well-defined schedule. The basic principle of nutritional management is to correct the nutritional status as well as to reduce the risk of nutritional deficiencies. Children with cholestasis usually need extra energy supply that can be obtained by increasing energy density of feeds or addition of glucose polymers and lipids. For catch-up growth, usually, protein intake should be increased. Lipid-soluble vitamin supplementation deserves special attention and it is not easy to correct poor vitamin E status. For some children, parenteral administration of vitamin K is needed. Since recently, a water-soluble vitamin E (d-α-tocopheryl polyethylene glycol 1000 succinate) given by oral route is used with a good therapeutic effect. As the liver disease progresses to liver failure in many chronic cholestatic diseases, nutritional therapy can often be regarded as ‘bridging’ for liver transplantation to improve prognosis. Thus, invasive nutritional support is justified in severe liver disease which usually includes nocturnal nasogastric tube feeding, or even parenteral nutrition.

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Cholestasis

2001

Diseases of the Liver and Biliary System

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Effect of orthotopic liver transplantation on bone mineral content and serum vitamin D metabolites in infants and children with chronic cholestasis

Cited by 48 publications

References 25 publications

Bone mineral density in long-term survivors following pediatric liver transplantation

Bone mineral density in long-term survivors following pediatric liver transplantation

Nutritional Management of Cholestatic Syndromes in Childhood

Cholestasis

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