Long‐term effect of childhood liver transplantation on body cell mass

Looi Cheng Ee, Rebecca Joanne Hill, Kerrie Beale, Charlton Noble, Jonathan Fawcett, Geoffrey John Cleghorn

Objective: Malnutrition is common in end-stage liver disease but correction after transplant is expected. Body cell mass (BCM) assessment using total body potassium (TBK) measurement is considered the "gold standard" for assessing nutritional status. The aim of this study was to examine BCM and therefore nutritional status of long-term survivors after childhood liver transplantation. Methods: Longitudinal nested cohort study of patients transplanted aged <18 years, surviving >3 years, with ongoing review at our centre. TBK measurements were obtained pre-transplant, and at long-term follow up. BCM was calculated from TBK and adjusted for height raised to the power p depending on gender (BCM/Height(p) ). The effect of age at transplant, linear growth impairment, biliary atresia diagnosis, and steroid use were assessed. Results: 32 patients, 20 males, participated. 62% had biliary atresia. Median age at transplant was 2.11 (range 0.38-10.92) years. Post-transplant testing was performed at median 7.23 (range 3.28-14.99) years when they were aged 10.12 (range 4.56-20.77) years. This cohort attained mean (±SD) Z-scores for height -0.41 (±1.36), weight -0.26 (±1.14), and body mass index 0.04 (±0.99). BCM/Height(p) was reduced pre-transplant but further reduced post-transplant (p<0.001) despite normalization of height and weight. Weight recovery is therefore likely from increased fat mass, not BCM. Linear growth impairment was associated with greater reduction in post-transplant BCM/Height(p) (p=0.02). On multivariate analyses, only older age at transplant predicted reduced post-transplant BCM/Height(p) (p=0.02). Gender, age at transplant, steroid use, and underlying diagnosis, did not predict change in BCM/Height(p) after transplant. Conclusions: Weight recovery in long-term survivors of childhood liver transplant is likely due to increased fat mass since BCM remains reduced. Nutritional compromise persists in long-term survivors of childhood liver transplant. Liver Transpl , 2014. © 2014 AASLD.