Liver transplantation: outcomesBeneficial effect of liver transplantation on bone mineral density in small infants with cholestasis☆
Section snippets
Patients and methods
Eleven cholestatic children (eight girls and three boys) were enrolled into the study a few days before living related liver transplantation. Their mean ± standard deviation of age was 9 months to 2.4 years (1.4 ± 0.5). In all cases, the initial cause of liver insufficiency was biliary atresia. All the children except one underwent hepatoportoenterostomy at the age of 2 to 3 months. Before the surgery, all subjects demonstrated elevated levels of bilirubin and liver enzymes (total bilirubin
Results
The mean value of 25OHD before LTx was within normal limits but two patients, including the child with the bone fracture, displayed low 25OHD values (both 9.7 ng/mL) and two had elevated 25OHD values (67.5 and 89.0 ng/mL). No changes were observed in serum levels of calcium, alkaline phosphates, and 25OHD before versus after LTx (Table 1). The serum levels of phosphorus and 1-25(OH)2D3 as well as total BMD and Cole index increased significantly after liver transplantation.
Discussion
Crosbie et al4 and Porayko et al5 demonstrated decreased BMD in adults within the first few months after liver transplantation. Also, most bone fractures occurred at the same time, and later gradually decreasing in frequency.
Following successful transplantation, the children's general condition improved due to adequate liver detoxication. Processes of absorption improved, which in turn had an impact on the BMI and the Cole index due to better bone metabolism and increased bone density. The
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