engleski

Linear growth after liver transplantation

Aim was to assess growth in 165 survivors of liver transplantation with follow-ups from 5 to 11 years after surgery. Medical records of 214 patients transplanted between March 1 1986 and March 30 1992 were reviewed. Height standard deviation scores (zH) and growth velocity scores (zGV) were computed for each of the 165 survivors over time. Factor analysis was performed with 51 variables describing demographic, pre and post transplant characteristics. At the time of transplantation 115 children were within 2SD for height (zH: -0.71) These patients have stayed within normal centiles (zH: -0.85) 9 yrs after transplantation. 50 children were below -2SD for height at the time of transplantation (zH: -3.08). These patients have had significant (p<0.01) catch-up growth reaching zH -1.99 and zH -1.53, 2.5 years and 9 yrs after transplantation respectively. There was no catch-up growth during the first 6 months after transplantation, but in the following 6 months catch- up growth was in the highest rank of the study period (1.06±2.94). Overall, all 165 patients showed catch up growth up to 6 years after transplantation. Slowing down of linear growth was observed after 7 yrs (zGV 0.03, p<0.01), but catch up growth had again occured 9 years after transplantation (zGV 1.12, p=0.01). Factor analysis showed 6 groups of factors with significant (p<0.01) independent impact on linear growth after transplantation: 1) age: children older than 13yrs at the time of transplantation had the most severe growth failure (zH -2.68) initially, which improved over time (zH -1.20, 9 yrs after transplantation) because they kept growing after age of 20 ; 2) liver disease: children with biliary atresia showed catch up growth first 6 yrs after transplantation and continued to grow as their healthy peers. The same trends, but of lower magnitude, were found for children with Alagille syndrome, with PFIC, and with miscellaneous pretransplant liver diseases (sclerosing cholangitis, autoimmune diseases, tumours). Patients with metabolic liver diseases grow well before, and even better after the transplantation ; 3) pretransplant complications: children who had not developed the complications of a long standing liver disease before the transplantation tend to grow much better after the transplantation ; 4) immunosupressive regimen: children with standard immunosupressive regimen (alternate day steroids plus cyclosporine) fared much better in terms of linear growth then those with higher dosage, or alternate regimens ; 5) early postoperative complications: most notably surgical, are one of the causes of impaired growth after transplantation ; and 6) absence of graft disease: there is striking difference in terms of growth between patients without and those with any type of chronic graft disease. Catch-up growth persists at least 6 years after transplantation. Children transplanted later in childhood tend to reach final height well beyond the time when growth is expected to stop. Finer adjustement of immunosupressive regimens, improvement of surgical techniques, refinement of diagnostics and therapy for posttransplant complications may improve growth after liver transplantation.

liver transplantation; children; linear growth

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