Analysis of growth during prepubertal years in long-term survivors after pediatric orthotopic liver transplantation.

BACKGROUND: Growth after pediatric liver transplantation (LT) has been the subject of reviews. The conclusions have not been consistent. OBJECTIVE: To describe post-LT growth patterns in prepubertal liver transplant recipients and identify variables affecting their growth. METHODS: Sixty-seven prepubertal transplant recipients met the inclusion criteria. Variables assessed were age, sex, pretransplant lack of growth, type of transplantation, primary diagnosis, liver and kidney function at one year post-LT, complications and retransplantation, prednisone therapy duration, allograft rejection episodes during the first year, cholesterol, triglycerides and immunosuppressive regimen. Mean follow-up was 3.5 years (range: 2-6 years). RESULTS: Growth according to baseline z-score, indications for transplantation and steroid withdrawal showed significant differences at 2 years post-LT. CONCLUSIONS: The causes of poorest z-scores in height post-LT were: height z-scores under -2.0 at transplantation, metabolic diagnosis, and use of steroids beyond 1 year post-LT.

Factors affecting catch-up growth after liver transplantation.

BACKGROUND: The reported incidence of catch-up growth following orthotopic liver transplantation (OLT) ranges widely, from 0% to 97%. OBJECTIVE: We undertook bivariate analysis of multiple factors that might affect post-OLT growth in children undergoing OLT, and described the results with different parameters used to determine catch-up growth. METHODS: Eighty patients met the inclusion criteria. RESULTS: Catch-up growth occurred in 14% during the first 6 months, 15% at 1 year, 39% at 2 years, 16% between 3 and 6 years, and 16% after 6 years post-OLT. The earlier catch-up growth was shown in metabolic diagnosis, patients over 10 years old and those without steroids at 1 year post-OLT. CONCLUSIONS: It is difficult to determine an acceptable definition of catch-up growth. We suggest that Zvel score > or =0 is the best parameter to evaluate catch-up growth, since the results are more normally distributed. Patients with prednisone withdrawal later than 1 year post-OLT and those with diagnosis of hepatitis and cirrhosis showed the slowest catch-up growth.

Two- to three-fold increase in blood tacrolimus (FK506) levels during diarrhea in liver-transplanted children.

BACKGROUND: The diagnosis and treatment of diarrhea in liver transplant recipients often pose a challenge owing to the variety of infectious and non-infectious causes. However, diagnosis is principally focused on ruling out an infectious etiology. Tacrolimus, an immunosuppressive agent generally used after liver transplantation, is absorbed mainly from the duodenum through the upper jejunum. It can be assumed that metabolism of the drug will be influenced by diarrhea. METHODS: Four liver transplant recipients who developed an episode of acute gastroenteritis. Infectious etiology was confirmed; trough tacrolimus levels were measured before, during and after gastroenteritis. RESULTS: All patients presented a two- to three-fold increase in blood tacrolimus levels after the onset of gastroenteritis. CONCLUSIONS: Until the role played by the intestine in the metabolism of tacrolimus is fully understood, it is prudent to recommend early dose reduction of tacrolimus and careful monitoring of trough levels during diarrheal disorders of any nature in pediatric liver-transplanted patients.