Linear growth after pediatric liver transplantation

To determine growth patterns in a large cohort of unselected children under going liver transplantation, the outcomes of 294 orthotopic liver transplan tations performed in 221 children at The University of Chicago between Octo ber 1984 and October 1992 were retrospectively reviewed; 66% were alive at the time of this analysis, The mean age at transplantation was 4.1 +/- 5.0 years; 44% of the children were male and 16% of the transplants were from l iving-related donors. The mean height z score at the time of transplantatio n was -1.6 +/- 1.8, and 39%, of children had height z scores of < -2.0 at t ransplantation. When children with growth retardation at the time of transp lantation (height z scores of < -2.0) were compared with children with more normal growth, there were no significant differences in gender or re-trans plantation rates, although children with growth retardation at transplantat ion were significantly younger than those with more appropriate growth (2.8 +/- 4.1 years vs 4.7 +/- 5.1 years, P < .05). The height a score of all ch ildren with biliary atresia at the time of transplantation was -1.9 +/- 1.7 compared with -1.2 +/- 2.0 in those children with underlying diseases othe r than biliary atresia. Catch-up growth was seen in 37% to 47% of children at any given time point after transplantation. Children with evidence of ca tch-up growth (growth velocity z score > 0) 2 years after transplantation w ere more likely to be first-time transplant recipients, had more growth ret ardation at the time of transplantation, and were receiving lower doses of prednisone at 2 years after transplantation. Younger children were most lik ely to demonstrate catch-up growth after transplantation. In summary, a lar ge proportion of children have growth retardation at the time of liver tran splantation This growth retardation is inversely correlated with age. Befor e transplantation, children with biliary atresia grow less well than childr en with other forms of liver disease. Up to one half of children demonstrat e catch-up growth after liver transplantation. Growth after transplantation is proportional to the degree of growth retardation at transplantation and inversely correlated to age at transplantation. Children with poor growth after transplantation are more likely to be receiving higher doses of corti costeroid.