Long-term effects of liver transplantation on bone mineral density in children with end-stage liver disease: a 2-year prospective study.
In children with end-stage liver disease, little is known regarding the long-term effects of liver transplantation on bone. In this 2-year prospective study, we evaluated the effects of liver transplantation on bone mineral density (BMD) and on other parameters of bone metabolism in 30 consecutive children with biliary atresia who underwent liver transplantation after failed Kasai operation. Tacrolimus and steroids were used as immunosuppressants. BMD of the first through fourth lumbar spine (L1-4) was measured by dual-energy radiographic absorptiometry (QDR-2000, Hologic) and expressed in Z-values. Before transplantation, Z-values of BMD, height, and weight were low in all patients (-3.4 +/- 0.34, -2.0 +/- 0.28, and -1.67 +/- O.16 [mean +/- SEM], respectively). Low BMD states were associated with low levels of serum 25-hydroxyvitamin D and serum levels of insulin-like growth factor-I (IGF-I), one of the most potent anabolic skeletal growth factors. Liver transplantation resulted in marked improvement in BMD values as well as in height and body weight: 24 months after transplantation, recovery was achieved in each parameter (0.16 +/- 0.30, -0.29 +/- 0.23, and 0.42 +/- 0.18, respectively). BMD recovery first was observed 3 months after transplantation. Moreover, these favorable effects of transplantation were accompanied by increases in serum levels of 25-hydroxyvitamin D and IGF-I. We conclude that liver transplantation effectively reverses the low bone mass status and growth retardation of children with end-stage liver disease.
Okajima
Hideaki
H
Department of Transplantation and Immunology, Kyoto University, Japan. hokajima@fc.kuh.kumamoto-u.ac.jp
Shigeno
Chohei
C
Inomata
Yukihiro
Y
Egawa
Hiroto
H
Uemoto
Shinji
S
Asonuma
Katsuhiro
K
Kiuchi
Tetsuya
T
Konishi
Junji
J
Tanaka
Koichi
K
D000293:Adolescent; D001656:Biliary Atresia / Q000150:complications; D001827:Body Height; D001835:Body Weight; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D006130:Growth Disorders / Q000209:etiology / Q000473:pathology; D006801:Humans; D007223:Infant; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D017093:Liver Failure / Q000150:complications / Q000209:etiology / Q000378:metabolism* / Q000601:surgery*; D016031:Liver Transplantation; D011184:Postoperative Period; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
D014807:Vitamin D; D007334:Insulin-Like Growth Factor I; C104450:25-hydroxyvitamin D