Bone mineral density and height gain in children with chronic cholestatic liver disease undergoing transplantation.
BACKGROUND
Osteodystrophy is a well-described complication of chronic liver disease. Previous reports in adults and children undergoing liver transplantation (LT) were discordant, with the former showing no improvement of bone disease in the first year after transplantation and the latter demonstrating remarkable benefit from it. Our aim was to perform a pilot study on osteodystrophy in children undergoing LT and evaluate the contribution of growth on bone mineral density (BMD) changes.


METHODS
We studied six patients (two male), with a median age at transplantation of 8.8 (range 3.8-16.6) years. Indications for transplantation were biliary atresia and progressive familial intrahepatic cholestasis (three patients each). BMD was studied with dual-energy x-ray absorptiometry and biochemical markers of liver and bone function in patients before and at 3, 6, and 12 months after LT.


RESULTS
Median L2-L4 spinal BMD was 0.54 g/cm2 (range 0.29-0.87) before LT, and 0.58 g/cm2 (0.27-0.86) at 3 months, 0.66 g/cm2 (0.36-1.00) at 6 months, and 0.76 g/cm2 (0.44-1.02) at 12 months after LT (P=0.005). Median height was 133 (range 93-167) cm before LT, and 134 (93-167) at 3 months, 136 (97-167) at 6 months, and 139 (102-167) at 12 months after LT. There was direct correlation between height gain and total body BMD improvement (r=0.929, P=0.007).


CONCLUSIONS
BMD in children with chronic cholestatic liver disease improves remarkably by 12 months after LT. Catch-up growth in children can account for the different effect of LT on bone density between adult and pediatric populations in the first year after surgery.
D'Antiga
Lorenzo
L
Paediatric Liver Service, Child Health Department, King's College Hospital, SE5 9RS London, UK.
Moniz
Caje
C
Buxton-Thomas
Muriel
M
Cheeseman
Paul
P
Gray
Beverly
B
Abraha
Hagosa
H
Baker
Alastair J
AJ
Heaton
Nigel D
ND
Rela
Mohammed
M
Mieli-Vergani
Giorgina
G
Dhawan
Anil
A
D000293:Adolescent; D000596:Amino Acids / Q000097:blood; D001827:Body Height; D015519:Bone Density; D001846:Bone Development; D001847:Bone Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D001842:Bone and Bones / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D002779:Cholestasis / Q000097:blood / Q000150:complications / Q000601:surgery*; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016014:Linear Models; D016031:Liver Transplantation; D008297:Male; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
D000596:Amino Acids; D010281:Parathyroid Hormone; D015675:Osteocalcin; D014807:Vitamin D; C036020:deoxypyridinoline; C104450:25-hydroxyvitamin D; D003404:Creatinine