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J Pediatr. 2013 Nov;163(5):1354-60.e1-7. doi: 10.1016/j.jpeds.2013.06.039. Epub 2013 Aug 2.

Long-term linear growth and puberty in pediatric liver transplant recipients.

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  • 1Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address:



To explore linear growth, puberty, and predictors of linear growth impairment among pubertal liver transplant recipients.


Review of data collected prospectively through the Studies of Pediatric Liver Transplantation registry. Thirty-one variables were tested as risk factors for linear growth impairment, and factors significant at P < .1 were included in a logistic regression model. Risk factor analysis was limited to 512 patients who had complete demographic and medical data.


A total of 892 patients surviving their first liver transplant by >1 year, with ≥ 1 height recorded, who were between 8 and 18 years old between the years 2005 and 2009 were included. Median follow-up was 70.2 ± 38.6 months, mean age was 12.9 ± 3.3 years, and mean height z-score (zH) was -0.5 ± 1.4 SD. Twenty percent had linear growth impairment at last follow-up. Of 353 subjects with Tanner stage data, 39% of girls and 42% of boys ages 16-18 years were not yet Tanner 5. Growth impairment rates were higher among boys than girls (30% vs 7%, P < .05) at Tanner stage 4, and occurred in 8/72 (11%) of Tanner 5 subjects. Among patients with parental height data, zH were lower than calculated mid-parental zH (P < .005). Independent predictors of growth impairment included linear growth impairment at transplant (OR 11.53, P ≤ .0001), re-transplantation (OR 4.37, P = .001), non-white race (P = .0026), and primary diagnosis other than biliary atresia (P = .0105).


Linear growth impairment and delayed puberty are common in pubertal liver transplant recipients, with pre-transplant growth impairment identified as a potentially modifiable risk factor. Catch-up growth by the end of puberty may be incomplete.


GGTP; Gamma glutamyltranspeptidase; Height z-score; MPH; Mid-parental height targets; Recombinant human growth hormone; SPLIT; Studies of Pediatric Liver Transplantation; rhGH; zH

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