Title: Effect of muscle mass on catch-up growth after liver transplant in infants with biliary atresia
Source: Pediatric Transplantation 2025, 29 (8): e70219
Date of publication: November 2025
Publication type: Cohort study
Abstract: Background: Loss of muscle mass is closely associated with short-term postliver transplant complications in children with biliary atresia. However, studies examining the impact of sarcopenia on long-term outcomes such as growth are very limited.
Methods: A cohort of 44 patients with a diagnosis of biliary atresia who underwent liver transplant before 18 months of age. All patients had baseline abdominal CT scans with measurement of the psoas muscle area. Height was recorded at several time points, and catch-up growth was defined as the increase in height Z-score between two measurements.
Results: During the first 6 months, patients exhibited growth stagnation, with a mean Δ height Z-score of -0.29 ± 0.91. Between 6 and 24 months, a marked catch-up growth occurred, with a Δ height Z-score of 0.62 ± 0.78. This was followed by a slower, gradual increase. Fifteen patients completed a 7-year follow-up, with a height Z-score of -0.52 ± 0.77. Psoas muscle mass was negatively correlated with catch-up growth from transplantation to 2 years after (r = -0.307, p = 0.043), and also from the 6-month nadir to 4 years after (r = -0.392, p = 0.016). When stratified into muscle mass tertiles, the lowest one showed significantly more catch-up growth compared to the highest one (p = 0.037). Baseline height Z-score, age at the time of transplantation, pediatric end-stage liver disease score, and the accumulated corticoid doses from 6 to 12 months showed significant correlations with the catch-up growth, but only muscle mass remained significant after multivariate analysis.
Conclusions: Children with lower muscle mass at the time of liver transplant demonstrated more pronounced and sustained catch-up growth.
