Background: Recent research suggests that measures of frailty, such as nutrition status, may be important predictors of surgical and transplant outcomes. The objectively calculated degree of malnutrition, including muscle and fat stores, experienced by pediatric patients with end-stage organ failure has not been well studied. This study compares children with end-organ disease to healthy, age-matched controls to determine the disparity in muscle and fat stores.

Methods: Children younger than age 19 with end-stage liver, kidney and intestine disease were extracted from the transplant database. Those children with computed tomography (CT) imaging within 6 months of transplant were then age and gender-matched to healthy controls from the trauma database. Measures of nutrition status included core muscle mass, perinephric and subcutaneous fat. Measurements of total psoas muscle area, total perinephric fat, and subcutaneous fat were measured at the L2/L3 disc space, and scaled to patient height.

Results: Liver (n=35), kidney (n=20) and intestine (n=26) transplant patients were included in the final analysis, with each individual child matched to a healthy control. Liver failure patients' primary diagnosis was biliary atresia (54%). Kidney failure patients' primary diagnosis was focal glomerular sclerosis (20%) and obstructive uropathy (15%). Intestine failure patients' primary diagnosis was gastroschisis (31%) and necrotizing enterocolitis (23%). Patients with end-stage liver disease had a 28% reduction in muscle, a 31% increase in visceral fat and an 8% increase in subcutaneous fat volume. Patients with end-stage renal disease had a 30% reduction in muscle and a 50% increase in subcutaneous fat volume. Visceral fat volume was not compared in this group because the atrophic kidneys resulted in unreliable measures of perinephric fat. Patients with intestine failure had a 44% reduction in muscle, a 12% increase in visceral fat and a 28% increase in subcutaneous fat.

Conclusions: These results demonstrate significant sarcopenia in patients with end-stage liver, kidney and intestine failure. These children, however, have increased fat stores suggesting an active physiologic mechanism to store fat while losing muscle mass. Sarcopenia may be related to total body protein loss either from decreased synthesis (liver), wasting (kidney) or malabsorption (intestine).

« Back to 2015 American Transplant Congress