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Alzaben AS, MacDonald K, Robert C, Haqq A, Gilmour SM, Yap J, Mager DR. Diet quality of children post-liver transplantation does not differ from healthy children. Pediatr Transplant 2017; 21. [PMID: 28557140 DOI: 10.1111/petr.12944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/28/2022]
Abstract
Little has been studied regarding the diets of children following LTX. The study aim was to assess and compare dietary intake and DQ of healthy children and children post-LTX. Children and adolescents (2-18 years) post-LTX (n=27) and healthy children (n=28) were studied. Anthropometric and demographic data and two 24-hour recalls (one weekend; one weekday) were collected. Intake of added sugar, HFCS, fructose, GI, and GL was calculated. DQ was measured using three validated DQ indices: the HEI-C, the DGI-CA, and the DQI-I. Although no differences in weight-for-age z-scores were observed between groups, children post-LTX had lower height-for-age z-scores than healthy children (P<.01). With the exception of vitamin B12, no significant differences in energy and macronutrient (protein, carbohydrate, and fat), added sugar, HFCS, fructose, GI, GL, and micronutrient intakes and DQ indices (HEI-C, DGI-CA, and DQI-I) between groups were observed (P>.05). The majority of children in both groups (>40%) had low DQ scores. No significant interrelationships between dietary intake, anthropometric, and demographic were found (P>.05). Both healthy and children post-LTX consume diets with poor DQ. This has implications for risk of obesity and metabolic dysregulation, particularly in transplant populations on immunosuppressive therapies.
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Affiliation(s)
- Abeer S Alzaben
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Krista MacDonald
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Cheri Robert
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Andrea Haqq
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Susan M Gilmour
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Jason Yap
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Division of Pediatric Gastroenterology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Diana R Mager
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Perito ER, Vase T, Ramachandran R, Phelps A, Jen KY, Lustig RH, Feldstein VA, Rosenthal P. Hepatic steatosis after pediatric liver transplant. Liver Transpl 2017; 23:957-967. [PMID: 28426902 PMCID: PMC5604881 DOI: 10.1002/lt.24773] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/07/2017] [Accepted: 03/24/2017] [Indexed: 02/06/2023]
Abstract
Hepatic steatosis develops after liver transplantation (LT) in 30% of adults, and nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in nontransplanted children. However, posttransplant steatosis has been minimally studied in pediatric LT recipients. We explored the prevalence, persistence, and association with chronic liver damage of hepatic steatosis in these children. In this single-center study of pediatric patients transplanted 1988-2015 (n = 318), 31% of those with any posttransplant biopsy (n = 271) had ≥ 1 biopsy with steatosis. Median time from transplant to first biopsy with steatosis was 0.8 months (interquartile range [IQR], 0.3-6.5 months) and to last biopsy with steatosis was 5.5 months (IQR, 1.0-24.5 months); 85% of patients with steatosis also had for-cause biopsies without steatosis. All available for-cause biopsies were re-evaluated (n = 104). Of 9 biopsies that could be interpreted as nonalcoholic steatohepatitis (NASH)/borderline NASH, with steatosis plus inflammation or ballooning, 8 also had features of cholestasis or rejection. Among 70 patients with surveillance biopsies 3.6-20.0 years after transplant, only 1 overweight adolescent had a biopsy with NAFLD (grade 1 steatosis, mild inflammation, no ballooning or fibrosis)-despite a 30% prevalence of overweight/obesity in the cohort and 27% with steatosis on previous for-cause biopsy. Steatosis on preceding for-cause biopsy was not associated with portal (P = 0.49) or perivenular fibrosis (P = 0.85) on surveillance biopsy. Hepatic steatosis commonly develops early after transplant in children and adolescents, but it rarely persists. Biopsies that did have steatosis with NASH characteristics were all for-cause, mostly in patients with NAFLD risk factors and/or confounding causes of liver damage. Prospective studies that follow children into adulthood will be needed to evaluate if and when hepatic steatosis presents a longterm risk for pediatric LT recipients. Liver Transplantation 23 957-967 2017 AASLD.
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Affiliation(s)
- Emily R. Perito
- University of California San Francisco, Department of Pediatrics
- University of California San Francisco, Department of Epidemiology and Biostatistics
| | - Tabitha Vase
- University of California San Francisco, School of Medicine
| | | | - Andrew Phelps
- University of California San Francisco, Department of Radiology and Biomedical Imaging
| | - Kuang-Yu Jen
- University of California Davis, Department of Pathology and Laboratory Medicine
| | - Robert H. Lustig
- University of California San Francisco, Department of Pediatrics
| | - Vickie A. Feldstein
- University of California San Francisco, Department of Radiology and Biomedical Imaging
| | - Philip Rosenthal
- University of California San Francisco, Department of Pediatrics
- University of California San Francisco, Department of Surgery
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Ng VL, Alonso EM, Bucuvalas JC, Cohen G, Limbers CA, Varni JW, Mazariegos G, Magee J, McDiarmid SV, Anand R. Health status of children alive 10 years after pediatric liver transplantation performed in the US and Canada: report of the studies of pediatric liver transplantation experience. J Pediatr 2012; 160:820-6.e3. [PMID: 22192813 PMCID: PMC4144332 DOI: 10.1016/j.jpeds.2011.10.038] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/12/2011] [Accepted: 10/27/2011] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine clinical and health-related quality of life outcomes, and to derive an "ideal" composite profile of children alive 10 years after pediatric liver transplantation (LT) performed in the US and Canada. STUDY DESIGN This was a multicenter cross-sectional analysis characterizing patients enrolled in the Studies of Pediatric Liver Transplantation database registry who have survived >10 years from LT. RESULTS A total of 167 10-year survivors were identified, all of whom received daily immunosuppression therapy. Comorbidities associated with the post-LT course included post-transplantation lymphoproliferative disease (in 5% of patients), renal dysfunction (9%), and impaired linear growth (23%). Health-related quality of life, as assessed by the PedsQL 4.0 Generic Core Scales, revealed lower patient self-reported total scale scores for 10-year survivors compared with matched healthy children (77.2±12.9 vs 84.9±11.7; P<.001). At 10 years post-LT, only 32% of patients achieved an ideal profile of a first allograft stable on immunosuppression monotherapy, normal growth, and absence of common immunosuppression-induced sequelae. CONCLUSION Success after pediatric LT has moved beyond patient survival. Availability of an ideal composite profile at follow-up provides opportunities for patients, families, and healthcare providers to identify broader sets of outcomes at earlier stages, ultimately contributing to improved outcomes after pediatric LT.
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Affiliation(s)
- Vicky L. Ng
- SickKids Transplant Center, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Estella M. Alonso
- Siragusa Transplant Center, Children’s Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John C. Bucuvalas
- Pediatric Liver Care Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | | | - James W. Varni
- Departments of Pediatrics and Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX
| | - George Mazariegos
- Hillman Center for Pediatric Transplantation, Children’s Hospital of Pittsburgh and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John Magee
- Division of Transplantation, University of Michigan Health System, Ann Arbor, MI
| | - Susan V. McDiarmid
- Dumont–University of California Los Angeles Liver Transplant Center, UCLA School of Medicine and Mattel Children’s Hospital, Los Angeles, CA
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McCormack L, Dutkowski P, El-Badry AM, Clavien PA. Liver transplantation using fatty livers: always feasible? J Hepatol 2011; 54:1055-62. [PMID: 21145846 DOI: 10.1016/j.jhep.2010.11.004] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 10/18/2010] [Accepted: 11/08/2010] [Indexed: 12/18/2022]
Abstract
Steatotic liver grafts represent the most common type of "extended criteria" organs that have been introduced during the last two decades due to the disparity between liver transplant candidates and the number available organs. A precise definition and reliable and reproducible method for steatosis quantification is currently lacking and the potential influence of the chemical composition of hepatic lipids has not been addressed. In our view, these shortcomings appear to contribute significantly to the inconsistent results of studies reporting on graft steatosis and the outcome of liver transplantation. In this review, various definitions, prevalence and methods of quantification of liver steatosis will be covered. Ischemia/reperfusion injury of the steatotic liver and its consequences on post-transplant outcome will be discussed. Selection criteria for organ allocation and a number of emerging protective strategies are suggested.
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Affiliation(s)
- Lucas McCormack
- Hepatobiliary Surgery and Liver Transplant Unit, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina
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