Mager Diana, Al-Zaben Abeer Salman, Robert Cheri, Gilmour Susan, Yap Jason
1 Department of Agriculture, Food, and Nutritional Sciences, University of Alberta, Edmonton, Canada.
2 Department of Pediatrics, University of Alberta, Edmonton, Canada.
JPEN J Parenter Enteral Nutr. 2017 May;41(4):632-640. doi: 10.1177/0148607115609524. Epub 2015 Sep 25.
Children post-liver transplantation (post-LTX) are at risk of growth delay and decreased bone mineral density (BMD) secondary to corticosteroid (CS) therapy and suboptimal intake of nutrients important for bone health. The pediatric LTX program at Stollery Children's Hospital introduced a CS-free LTX regimen in 2003. This retrospective study investigated whether the implementation of a CS-free protocol resulted in improvements in BMD (dual x-ray absorptiometry) and growth following LTX.
A retrospective chart review of all children undergoing LTX was conducted. The parameters included repeated measures of anthropometric (weight, weight z score, height, height z score), BMD/bone mineral content (BMC), laboratory variables, graft function (number/severity of rejection), and CS therapy (dose, duration).
A total of 39 patients met study inclusion (20 male; n = 28 on CS; n = 11 CS-free). Mean duration of follow-up was 5.5 ± 3.3 years. The mean weight and height z scores were -0.31 ± 0.14 (CS) and 0.22 ± 0.23 (CS-free; P = .09) and -0.71 ± 0.13 (CS) and 0.23 ± 0.22 (CS-free; P = .002), respectively. Lumbar and whole-body BMD z score less than -2 were present in 15% and 8% of the cohort, respectively. There were no significant differences between CS and CS-free in lumbar BMC (22.2 ± 1.4 and 23.4 ± 2.02 g; P = .165) and lumbar BMD (0.57 ± 0.02 and 0.80 ± 0.22 g/cm; P = .152), respectively. Lumbar BMC ( r = 0.89, P < .05) and whole-body BMC ( r = 0.93, P < .05) were inversely related to CS dose >0.2 mg/kg/d and positively related to bone age ( P < .01).
CS therapy in children post-LTX is associated with reduced BMC and delayed linear growth. Understanding the clinical and nutrition factors influencing bone health is important to optimizing growth and bone health in children post-LTX.
肝移植术后儿童有生长发育迟缓及骨密度（BMD）降低的风险，这继发于皮质类固醇（CS）治疗以及对骨骼健康重要的营养素摄入不足。斯托勒里儿童医院的儿科肝移植项目于2003年引入了无CS肝移植方案。这项回顾性研究调查了无CS方案的实施是否能改善肝移植术后的骨密度（双能X线吸收法）及生长情况。
对所有接受肝移植的儿童进行回顾性病历审查。参数包括人体测量学指标（体重、体重Z评分、身高、身高Z评分）、骨密度/骨矿物质含量（BMC）、实验室指标、移植物功能（排斥反应的次数/严重程度）以及CS治疗（剂量、持续时间）的重复测量值。
共有39例患者符合研究纳入标准（20例男性；28例接受CS治疗；11例未接受CS治疗）。平均随访时间为5.5±3.3年。平均体重Z评分在接受CS治疗组为-0.31±0.14，未接受CS治疗组为0.22±0.23（P=0.09）；平均身高Z评分在接受CS治疗组为-0.71±0.13，未接受CS治疗组为0.23±0.22（P=0.002）。队列中分别有15%和8%的患者腰椎和全身骨密度Z评分低于-2。接受CS治疗组和未接受CS治疗组在腰椎BMC（22.2±1.4和23.4±2.02 g；P=0.165）和腰椎骨密度（0.57±0.02和0.80±0.22 g/cm；P=0.152）方面无显著差异。腰椎BMC（r=0.89，P<0.05）和全身BMC（r=0.93，P<0.05）与CS剂量>0.2 mg/kg/d呈负相关，与骨龄呈正相关（P<0.01）。
肝移植术后儿童的CS治疗与BMC降低及线性生长延迟有关。了解影响骨骼健康的临床和营养因素对于优化肝移植术后儿童的生长及骨骼健康很重要。
