Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
J Pediatr. 2013 Nov;163(5):1354-60.e1-7. doi: 10.1016/j.jpeds.2013.06.039. Epub 2013 Aug 2.
To explore linear growth, puberty, and predictors of linear growth impairment among pubertal liver transplant recipients.
Review of data collected prospectively through the Studies of Pediatric Liver Transplantation registry. Thirty-one variables were tested as risk factors for linear growth impairment, and factors significant at P < .1 were included in a logistic regression model. Risk factor analysis was limited to 512 patients who had complete demographic and medical data.
A total of 892 patients surviving their first liver transplant by >1 year, with ≥ 1 height recorded, who were between 8 and 18 years old between the years 2005 and 2009 were included. Median follow-up was 70.2 ± 38.6 months, mean age was 12.9 ± 3.3 years, and mean height z-score (zH) was -0.5 ± 1.4 SD. Twenty percent had linear growth impairment at last follow-up. Of 353 subjects with Tanner stage data, 39% of girls and 42% of boys ages 16-18 years were not yet Tanner 5. Growth impairment rates were higher among boys than girls (30% vs 7%, P < .05) at Tanner stage 4, and occurred in 8/72 (11%) of Tanner 5 subjects. Among patients with parental height data, zH were lower than calculated mid-parental zH (P < .005). Independent predictors of growth impairment included linear growth impairment at transplant (OR 11.53, P ≤ .0001), re-transplantation (OR 4.37, P = .001), non-white race (P = .0026), and primary diagnosis other than biliary atresia (P = .0105).
Linear growth impairment and delayed puberty are common in pubertal liver transplant recipients, with pre-transplant growth impairment identified as a potentially modifiable risk factor. Catch-up growth by the end of puberty may be incomplete.
探讨青春期肝移植受者的线性生长、青春期及线性生长受损的预测因素。
通过小儿肝移植研究登记处前瞻性收集的数据进行回顾。对 31 个变量进行了测试，作为线性生长受损的危险因素，具有统计学意义（P<.1）的因素被纳入逻辑回归模型。危险因素分析仅限于 512 名具有完整人口统计学和医学数据的患者。
纳入了 892 名在 2005 年至 2009 年期间接受首次肝移植后存活超过 1 年、至少有 1 次身高记录且年龄在 8 至 18 岁之间的患者。中位随访时间为 70.2±38.6 个月，平均年龄为 12.9±3.3 岁，平均身高 z 评分（zH）为-0.5±1.4SD。20%的患者在最后一次随访时出现线性生长受损。在 353 名有 Tanner 分期数据的患者中，39%的女孩和 42%的男孩在 16-18 岁时尚未达到 Tanner 5 期。在 Tanner 4 期，男孩的生长受损率高于女孩（30%比 7%，P<.05），而在 Tanner 5 期的 8/72（11%）名患者中发生。在有父母身高数据的患者中，zH 低于计算的中亲 zH（P<.005）。生长受损的独立预测因素包括移植时的生长受损（OR 11.53，P≤.0001）、再次移植（OR 4.37，P=.001）、非白种人（P=.0026）和原发性诊断不是胆道闭锁（P=.0105）。
青春期肝移植受者线性生长受损和青春期延迟较为常见，移植前生长受损被确定为一个潜在的可改变的危险因素。青春期结束时的追赶生长可能不完全。
