https://www.ncbi.nlm.nih.gov/pubmed/29287007
J Pediatr Gastroenterol Nutr. 2017 Dec 28. doi: 10.1097/MPG.0000000000001881. [Epub ahead of print]

Ee LC, Noble C, Fawcett J, Cleghorn GJ.

Abstract

OBJECTIVES:
Liver transplant patients are at risk of osteopenia and fractures but limited information is available in long-term survivors after childhood transplantation. This study aimed to assess bone mineral density (BMD) of very long-term, >5 years, survivors after liver transplantation in childhood.

METHODS:
Patients aged <18 years at transplant, having survived >5 years after transplant were potentially eligible but only those with ongoing review in our state were included. Dual-energy absorptiometry (DXA) was used to measure BMD. Patients aged <20 years had lumbar spine (LS) and total body (TB) measurements while those aged 20 years or more had LS and femoral neck but not TB. BMD Z-scores for LS and TB if available were used in this study. BMD Z-score ≤ -2.0 was considered reduced. Pre-pubertal children had radiologic bone age assessment.

RESULTS:
42 patients, 17 males, participated of whom 64% had biliary atresia. Median age at transplant was 2.22 (range 0.38-14.25) years; time since transplant 10.10 (5.01-25.98) years; and age at DXA 14.64 (6.59-38.07) years. Mean BMD Z-scores were LS -0.15 ± 1.07, and TB -0.76 ± 1.14, with no gender difference noted. Four (9.5%) patients had reduced LS BMD, and although ongoing steroid use was more frequent in these patients, other co-morbidities were likely important. Age at transplant, time since transplant, height, weight, and body mass index at DXA did not predict LS BMD. Pathologic fractures occurred in 2/42 (5%) patients; all within 18 months of transplant.

CONCLUSIONS:
Very long-term survivors after childhood liver transplant have LS BMD within the normal range.