Growth of long term survivors of liver transplantation

Abstract

Objective-To assess growth in survivors of liver transplantation. Study design-Growth was studied in 105 children up to seven years after liver transplantation. Results-At transplantation, mean height standard deviation score (zH) was −1.22 but 19% of patients were severely growth retarded (height below 0.4th centile). Growth and pubertal retardation were seen in the first six months after liver transplantation. Significant catch up in growth and puberty continued for more than five years. At five years, mean zH was −0.95 and at seven years −0.84. The mean zH of patients at final height was −0.55. zH at six months was predicted by zH and bilirubin at the time of transplantation and prednisolone dose at six months. At four years, zH was predicted by zH at the time of transplantation and the cumulative prednisolone dose. There was no association between zH and age at transplantation, sex, or diagnosis, although those with biliary atresia and those undergoing transplantation under 2 years of age showed more initial growth delay and subsequent catch up. Average age at menarche was 14.2 years. Conclusions-The mean height of the group to have reached final height after liver transplantation was on the 27th centile. Those transplanted earlier in childhood are likely to achieve more normal final heights. High steroid dose, poor liver function, and retransplantation are associated with poorer height outcomes. Persisting severe short stature is largely confined to children with severely retarded growth at the time of transplantation. Transient delay in puberty and menarche occur early after transplantation, although appropriate pubertal progress is resumed after two to three years. (Arch Dis Child 1999;80:235-240)

Randomized Trial of Basiliximab Induction versus Steroid Therapy in Pediatric Liver Allograft Recipients Under Tacrolimus Immunosuppression

“…In the BAS group, no death was considered to be definitely related to BAS. In one case we considered the cause of death to be possibly related to study medication: a 17-year-old boy transplanted for acute liver failure secondary to liver trauma with a whole liver from a 79-year-old donor died on the 9th postoperative day because of enterococcus sepsis and multiple or- 2 Seven deaths in 12-month study period analyzed, steroids, n = 3; basiliximab, n = 4.…”

“…However, steroid avoidance could be beneficial, particularly in pediatric recipients because, when administered for a prolonged period, they are associated with multiple severe side effects including infections, arterial hypertension, glucose intolerance, hyperlipidemia, osteoporosis and growth impairment (2)(3)(4). Moreover, work in rodents suggests that the administration of steroids may interfere with the development of immunological tolerance, as well as with the process of hepatic regeneration (5,6).…”

268 Pediatric Liver Transplantation

“…In addition, patients taking steroids carry an increased risk for developing malignancies, especially lymphomas and skin cancers [104] . Detrimental metabolic effects of steroids are wide ranging and are of particular concern for the pediatric transplant patient [105][106][107] . In terms of hospital costs, the calculated 10-year cumulative expense for steroid-related complications in adult kidney recipients has been shown to be 5300 $ per patient per year [108] .…”

Long-term nutritional and cognitive outcomes after liver transplantation in childhood

“…Pre-transplant factors including height Z-score at transplant, age at transplant, gender, and underlying diagnosis have all been reported to be important in determining height growth 26,[49][50][51] . Other variables including donor age, post-transplant hepatic vein stenosis, and steroid dose have also been reported to be important determinants of growth in children [52][53][54] . There remains however, limited data on long-term growth after liver transplantation in childhood.…”

“…There remains however, limited data on long-term growth after liver transplantation in childhood. Several studies have reported children to attain height around the 25-30 th centile, 7-10 years after transplant 34,35,54 . This duration of review however does not allow for full growth potential as many children will not complete growth until aged 20 years.…”