C. M. Schmidt II1, R. S. Mangus1 1Indiana University School Of Medicine,Surgery/Transplant,Indianapolis, IN, USA
Introduction:
Pediatric patients with liver disease suffer from hypoalbuminemia, loss of muscle mass, and malnutrition. After transplant (TX), serum albumin (ALB) levels normalize at variable rates. This study aims to quantify differential rates of post-TX normalization of nutritional markers (ALB, BMI, and BW) with subgroup analysis of patient pre-TX baseline nutritional status (muscle mass (MM), BMI, and ALB) and patient demographics.
Methods:
A retrospective review of a prospectively collected transplant database (2001-2018) at a single center was performed. Weekly ALB values and monthly BWs and BMIs were collected post-TX. A select group with CT imaging pre-TX underwent scaled scoring of core muscle mass (psoas muscle cross-sectional area at the L2/L3 intervertebral space divided by height2). ANOVA was used to compare subgroup nutritional marker reversal rates.
Results:
A total of 114 patients met study criteria, 82 with CT imaging analysis. Pre-transplant, 45% had severe sarcopenia. ALB normalized at a median time of 5 weeks for the whole population. Patients with lower baseline ALB had a lower median time to normalization of ALB (P<0.01). Normalization rate of median ALB levels lagged behind in those aged <2 compared to those aged >2 (p<0.05). Normalization rate of median ALB was faster in patients with BMI>23 compared to patients with BMI<23 (p<0.05). BMI and BW were unchanged except in those aged>11 who had an acute decrease in both in the first 30 days. Median ALB normalization rate by MM showed no significance when grouping by 3 levels of sarcopenia, but clearly there is a paradoxical more robust normalization rate in severe sarcopenia patients if solely compared to mild/no sarcopenia.
Conclusion:
Liver TX dramatically reverses hypoalbuminemia at differential rates according to age, pre-TX BMI and ALB levels. Despite normalization liver TX does not change BW and BMI. Those that struggle resolving their hypoalbuminemia have the lowest age and pre-TX BMI and ALB. Paradoxically, severe sarcopenia median ALB levels remained the highest throughout most of the first 7 weeks. The finding was not significant comparing all 3 groups, but a larger sample size could reveal a significant relationship mirroring this finding in the adult population. We speculate that a sarcopenic-dependent novel “ALB-stimulating factor” may exist at higher levels in severe sarcopenic patients. Understanding the differences in post-TX normalization rates according to pre-TX nutritional status, and demographic differences in this population are crucial to optimizing patient care.
