Growth of long term survivors of liver transplantation

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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. Average final height after liver transplantation was on the 27th centile, although those undergoing transplantation as infants can achieve better final heights Height at transplantation is the most important predictor of later height outcome, emphasising the need for optimal transplant timing and preoperative nutritional management High steroid dose, poor liver function, and the need for a second transplant were associated with poor height outcome Transplantation in infancy was not associated with poorer height outcomes Normal pubertal progress was resumed three to five years after transplantation