Growth and nutritional evaluation in children with chronic liver disease (CLD) before and after liver transplantation

Acute or final hepatic insufficiency needs to be treated with hepatic transplantation. It represents an important cause of growth retardation mainly due to decrease of daily caloric intake and macro-/micronutrient adsorption and alteration of hepatic metabolism. Sometimes nutritional supplementation may be necessary. Aim of this study is to evaluate growth and nutritional status in children with hepatic insufficiency before and after hepatic transplantation.Ten children (4 boys and 6 girls; 3-13 years; 8 biliary atresy, 1 type I tyrosinemia, 1 Alagille’s Syndrome) were included in the study. Height, weight, and laboratory (albumin, hepatic and biliary index, lipids profile, coagulation) data were detected before, after 1, and 3 year hepatic transplantation. Insulin-like growth factor 1 (IGF-1), IGF-binding protein 3 (IGF-BP3), vitamin B12, and folic acid were measured only at the last visit. Parametric statistical analysis was performed. The auxological and laboratory characteristics of the patients are reported in the Table (p<0.05; *1 year vs. before; **3 years vs. both before and 1 year). Basal growth parameters were slightly compromised. Weight and BMI z-score significantly increased already 1 year after hepatic transplantation, resulting within normal range also at 3 years, while height z-score was significantly improved only after 3 years. Albumin levels resulted slightly impair before transplantation and significantly increase at the last control. A significant progressive decreased of bilirubin, biliary acid, alkaline phosphatase, and transaminase values was found after 1 and 3 years, finally resulting in the normal range. No other significant change was demonstrated for laboratory data. At the last evaluation nutritional and growth index (IGF-1 and IGF-BP3) were within normal range for age and sex. Our results confirm that a correct diet, sometimes supported by enteral nutrition, make it possible to obtain a satisfactory nutritional status before hepatic transplantation. This approach allows a more rapid improvement of growth already 1 year after surgery. IGF-1 levels may be considered an useful tool to evaluate clinical and nutritional status of these patients.