Persistence of Sarcopenia After Pediatric Liver Transplantation Is Associated With Poorer Growth and Recurrent Hospital Admissions. Issue 2 (23rd July 2018)

• Record Type: Journal Article
• Authors: Mager, Diana R.; Hager, Amber; Ooi, Poh Hwa; Siminoski, Kerry; Gilmour, Susan M.; Yap, Jason Y.K.
• Is Part Of: JPEN, Journal of parenteral and enteral nutrition. Volume 43:Issue 2(2019)
• Page Start: 271
• Page End: 280
• Publication Date: 2018-07-23
• Subjects: growth -- healthcare utilization -- liver transplantation -- pediatric -- sarcopenia; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; 615.85484
• DOI: 10.1002/jpen.1414
• Languages: English
• ISSNs: 0148-6071

Abstract

Abstract: Introduction: Sarcopenia is prevalent in adults pre‐liver transplantation (LTx) and post‐LTx contributing to adverse outcomes. Little is known regarding the prevalence of sarcopenia in pediatric LTx recipients. This novel study examined sarcopenia prevalence and associations with post‐LTx growth and healthcare utilization in pediatric LTx recipients. Methods: We prospectively assessed body composition at annual clinical appointments in children (0.5–17 years; n = 58) by Dual‐energy‐X‐ray absorptiometry (absolute/regional/percent fat mass [FM], fat‐free mass [FFM], skeletal muscle mass [SMM]). Sarcopenia was defined as SMM z scores ≤2. Additional variables measured included age, gender, PELD, immunosuppressive therapies (dose/type), weight, weight‐ z, height, height‐ z, serum aspartate aminotransferase, alanine aminotransferase, γ‐glutamyltransferase, albumin, total/conjugated bilirubin, prothrombin time, international normalized ratio, albumin, creatinine clearance, urea and creatinine at LTx assessment, LTx and annual clinic appointments. Healthcare variables studied included rejection (number/type/severity), length of in‐patient stay (total, intensive care unit [ICU], emergency, readmission) and ventilator dependency. Results: Sarcopenia occurred in 41% (n = 17) at 7.6 (± 3.1) years; with a mean time post‐LTx of 1.1 ± 1.9 (1–8) years. Female children ≤9.8 years had a higher sarcopenia prevalence than children >9.8 years (83.1% vs 17.1%; p = 0.004). Sarcopenia was associated with lower weight velocity standard deviation scores, lower weight‐ z /height‐ z scores at 2–10 years post LTx, increased hospitalization (total, ICU, emergency and readmission) and ventilator dependency ( p < 0.05), but not to rejection and/or corticosteroid therapy ( p > 0.05). Conclusions: This is the first study demonstrating persistent sarcopenia associated with poorer growth and recurrent hospitalization in children post‐LTx.