2017 - CIRTA


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5- Outcomes after Intestinal Transplantation

16.9 - Sarcopenia in children with intestinal transplantation

Presenter: Robert, Hegarty, London, United Kingdom
Authors: Robert Hegarty, Pamela Allen, Annamaria Deganello, Maria Sellars, Jonathan Hind, Dhamyanthi Thangarajah

Sarcopenia in children with intestinal transplantation

Robert Hegarty1, Pamela Allen2, Annamaria Deganello2, Maria Sellars2, Jonathan Hind1, Dhamyanthi Thangarajah1.

1Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, United Kingdom; 2Paediatric Radiology Department, King's College Hospital, London, United Kingdom

Objectives and study: Deficits in lean mass are well described in children with chronic disease e.g. inflammatory bowel disease [1]. Sarcopenia is a poor prognostic biomarker in adults with liver transplantation and in children with acute lymphoblastic leukaemia [2-3]. Psoas muscle cross sectional area (PCA) correlates with whole body muscle mass and can be measured from axial imaging [4]. Little is known about sarcopenia in children with intestinal transplantation (IT). The primary objective was to determine whether children who had IT show differences in total PCA when compared to healthy controls. The secondary objective was to investigate association of PCA and survival after IT.

Methods: A retrospective, case note review of children who had IT at a our centre since inception in 2009 to May 2016 was undertaken; controls obtained from trauma series. Total PCA (mm2) was measured using magnetic resonance imaging or computed tomography at the level of the anterior superior iliac spine. To correct for body size, PCA index was derived for all subjects: PCA divided by height, and described according to outcome. Statistical analysis was carried out using Social Sciences (SPSS) version 23.

Results: Sixteen patients(9 male) underwent IT; post-transplant axial imaging was available for 12(6 male). The median age was 6.2[3.6 to 12.91] years in whom the diagnoses were(n): chronic intestinal pseudo-obstruction(3), gastroschisis(3), intestinal ischaemia(1), intestinal lymphangiectasia(1), volvulus(1), progressive familial intrahepatic cholestasis(1), Hirschsprung’s disease(1) and intestinal failure of indeterminate aetiology(1). One patient was excluded from the analysis as she was a bilateral amputee. Children who had IT had a significantly lower PCA and PCA index than controls; median PCA index (x10-3mm2) [IQR] in IT vs controls; 4.71[3.68 to 6.10] vs 9.55[8.44 to 11.33], p<0.05. A higher PCA index was observed in IT patients who survived(n= 9) vs those who did not(n=2). 

Figure 1: PCA index in IT - deceased versus alive

Conclusion: Children who underwent IT had sarcopenia of the psoas muscle in comparison to healthy controls; sarcopenia was more severe in IT patients who died. This study adds to the evidence that body core muscle is consistently deficient in children with chronic disease. It is the first to comment on children with IT and provides the basis to develop PCA as a prognostic marker in children with transplantation.

[1][2][3][4]

[1] Thangarajah, D., et al., Systematic review: Body composition in children with inflammatory bowel disease. Aliment Pharmacol Ther, 2015. 42(2): p. 142-57.
[2] Rayar, M., et al., Sarcopenia in children with acute lymphoblastic leukemia. J Pediatr Hematol Oncol, 2013. 35(2): p. 98-102.
[3] Englesbe, M.J., et al., Sarcopenia and mortality after liver transplantation. J Am Coll Surg, 2010. 211(2): p. 271-8.
[4] Morrell, G.R., et al., Psoas Muscle Cross-sectional Area as a Measure of Whole-body Lean Muscle Mass in Maintenance Hemodialysis Patients. J Ren Nutr, 2016. 26(4): p. 258-64.


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