# Growth in children with biliary atresia before and after liver transplantation: a retrospective analysis

## TL;DR

This study examines how children with biliary atresia grow before and after liver transplants, finding that catch-up growth peaks two years post-surgery.

## Contribution

The study provides new insights into long-term growth outcomes and factors influencing catch-up growth after liver transplantation in children with biliary atresia in China.

## Key findings

- Catch-up growth in height peaks two years after liver transplantation.
- Preoperative growth delays correlate with faster postoperative growth improvement.
- Biliary complications are linked to impaired catch-up growth post-transplantation.

## Abstract

Little is known about the long-term survival and growth outcomes of children following liver transplantation in China. Therefore, we investigated the long-term survival and growth status of children with biliary atresia (BA) before and after liver transplantation and attempted to identify specific influencing factors.

We included children who underwent liver transplantation for BA at Tianjin First Central Hospital between January 2014 and December 2018. Clinical data, indicators of liver function, growth data, and ascites status were collected for analysis from all patients. Postoperative complications were systematically assessed using a combination of clinical, laboratory, histological, and imaging evaluations. Complications were categorized and graded according to the Clavien–Dindo classification system.

This study included a total of 93 children under 2 years of age who underwent liver transplantation for BA. No significant increase in height was observed six months post-transplantation when compared to pre-transplantation (P = 0.126). A significant increase in the height-for-age Z-score occurred by year 2 (P = 0.001). Preoperative growth was negatively correlated with growth improvement at 2- and 5-years after transplantation (P < 0.001, r = −0.674 and r = −0.774, respectively). The occurrence of biliary complications was significantly associated with impaired catch-up growth post-transplantation (P = 0.008). The weight-for-age Z-score increased significantly over the first two years post-transplantation when compared with that before transplantation (P < 0.001); subsequently, this parameter plateaued and exhibited only minimal changes.

Growth retardation is common in children with BA prior to liver transplantation, with catch-up growth commencing six months post-surgery and peaking after two years. Children with more severe preoperative growth delays exhibited faster postoperative growth. Preoperative growth status exhibited only minimal impact on early liver function recovery post-transplantation.