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Abstract
Introduction/Background Sarcopenia predicts morbidity and mortality in patients with end-stage chronic liver disease (ESCLD).
Aim To describe changes in body composition in children with ESCLD before and after liver transplantation (LT) and correlate with clinical parameters.
Subjects/Methods Retrospective analysis of whole body DXA scans performed before and after LT of children with ESCLD (5 years old and above) who were assessed for LT during 2014–2019 at the Children’s Liver Unit in Leeds. Fat mass and lean mass was recorded for arm, leg, trunk and whole body and was expressed as fat mass index (FMI) and lean mass index (LMI) and converted to z-scores using UK WHO reference data in ImsGrowth program©. Sarcopenia was defined as leg LMI z-score < -1.96.
Results We studied 25 DXA scans of children before LT, 26 children at 1 year after LT (19 children were the same at baseline), 15 at 2 years after LT (10 were the same at baseline), 10 at 3 years post LT (7 of which at baseline) and 7 at 4 years post LT (5 of which at baseline). Figure-1 shows Leg LMI before and after LT.
Overall leg LMI z-score had a significant correlation (Spearman’s rho) with Weight (0.8)**, Height (0.48)* and BMI z-score (0.77)**, arm LMI (0.75)*, trunk LMI (0.53)** and total LMI z-score (0.86)**PLTs (-0.57**), Neu (-0.50)*, WCC (-0.44)* and days to discharge (-0.46)*. Days to discharge also correlated with BMI z-score (-0.51)** and Hb (0.43)*.
At baseline: Age median 11.7 years (SD 2.98), weight z-score median -0.35 (SD 1.41), height z-score median -0.61 (SD 1.62) and BMI z-score median -0.3 (SD 0.87). 13/25 children were sarcopenic. They had significantly lower weight, BMI, arm LMI, leg FMI, trunk LMI and total LMI z-scores in comparison to the other 12 children and stayed in hospital after liver transplant for longer.
Eight children were stunted. They had a significantly lower weight z-score and higher white cell count (WCC) and Ne/Ly ratio in comparison to the other 17 children.
All children had FM indices within the normal range.
One year after LT, 12/26 children remained sarcopenic. Seven were stunted and all had normal FM indices. Two years after LT, 5/15 were sarcopenic, all had normal FM indices and 5 were stunted. Three years after LT, 1 of the 10 children was sarcopenic and 2 were stunted. By 4 years after LT, 1/7 was sarcopenic and the same one was stunted.
**p<0.01 *p<0.05
Summary/Conclusion 52% of patients were sarcopenic at baseline. Indices of lean mass improved after LT and were mostly within the normal range by 4 years after LT. 32% of children were stunted and surrogate markers of inflammation (Ne/Ly) correlated with stunting. Sarcopenia correlated negatively with indirect markers of hypersplenism.
Body composition in children with ESCLD shows preserved fat mass at the cost of lean mass. Systemic inflammation and portal hypertension are associated with these perturbations.
Leg LMI z-score at baseline and after LT