Orthotopic liver transplantation reverses the adverse nutritional changes of end-stage liver disease in children.

The changes in growth and body composition after orthotopic liver transplantation (OLT) were studied in 61 children (median age at OLT 3.49 y (range: 0.04-14.5 y), 26 boys and 35 girls) who had survivedI y post-OLT. Height, weight, midarm circumference (MAC), triceps skinfold thickness (TSF), and subscapular skinfold thickness (SSF) were measured at OLT, 3 and 6 mo later, then annually up to 5 y. SD scores (SDS) were derived from population standards. Results are reported as mean SDS ± SEM. At OLT the children were short and malnourished (height: -0.98 ± 0.22: weight: -0.82 ± 0.18: MAC: -1.77 ± 0.21; TSF: -1.27 ± 0.17; SSF: -1.49 ± 0.17). By 3 mo post- OLT, there was a sustained improvement in MAC (-0.73 ± 0.22), 1SF (-0.47 ± 0.18), and SSF (-0.50 ± 0.18). Weight SDS (-0.48 ± 0.20) improved by 6 mo without significant change in height SDS. The three children with Alagille syndrome were smaller (height, weight, and MAC) than children with other diag- noses but did show catch-up growth. Fulminant hepatic failure was not associated with growth failure before or after OLT. Infants (ii = 14) were smaller and more malnourished at OLT (smaller skinfold thicknesses and lower weight SDS) than those who re- ceived transplants at an older age. By 1 y post-OLT, the only persisting difference was in TSF. Abnormal liver function at 1 y post-OLT (n = 8) and repeated episodes of steroid-treated rejec- tion (ii = 13) were associated with worsening height and weight SDS. The use of tacrohimus for graft salvage from rejection (ii = 6) was not associated with growth failure. In conclusion, end-stage liver disease has a more adverse effect on MAC, TSF, and SSF than on height and weight, but a marked and rapid improvement occurred post-OLT. Children who were most severely malnour- ished and growth restricted at the time of OLT showed the greatest catch-up growth after OLT. Am J C/in Nuir 1997:65:534-42.