Linear Growth Patterns in Prepubertal Children Following Liver Transplantation

Publication Type
Journal Article
Year of Publication
2009
Authors
Alonso, E M; Shepherd, R; Martz, K L; Yin, W; Anand, R; the SPLIT Research Group
Secondary
Am J Transplant
Volume
9
Start Page
1389
Pagination
1389-1397
Date Published
06/2009
Keywords
Body Height; Child; Child Development; Child, Preschool; Female; Follow-Up Studies; gamma-Glutamyltransferase; Growth Disorders; Humans; Infant; liver transplantation; Male; Multivariate Analysis; Registries; Steroids
Abstract

Factors impacting linear growth following pediatric liver transplantation (LT) are not well understood. This longitudinal analysis examines predictors of linear growth impairment in prepubertal children included in Studies of Pediatric Liver Transplantation. In 1143 children with serial measurements, mean height scores increased from -1.55 at LT to -0.87 and -0.68 at 24 and 36 months post LT with minimal subsequent catch up growth observed until 60 months. Subgroup analysis of height measurements at 24 months (n = 696), 33.8% were below 10th percentile at 24 months post LT. Multivariate analysis revealed linear growth impairment more likely in patients with metabolic disease (OR 4.4, CI: 1.83-10.59) and >18 months of steroids exposure (OR 3.02, CI: 1.39-6.55). Higher percentiles for weight (OR 0.80, CI: 0.65-0.99) and height (OR 0.62, CI: 0.51-0.77) at LT decreased risk. Less linear catch up was observed in patients with metabolic disease, non-Biliary atresia cholestatic diseases and lower weight and higher height percentiles prior to LT. Prolonged steroid exposure and elevated calculated glomerular filtration rate and gamma-Glutamyltransferase following LT were associated with less catch up growth. Linear growth impairment and incomplete linear catch up growth are common following LT and may improve by avoiding advanced growth failure before LT and steroid exposure minimization.