膽道閉鎖兒肝移植前後之生長及骨密度狀況

Severe malnutrition of a chronic liver disease patient before transplantation is associated with a higher rate of morbidity, mortality and a higher incidence of post-transplantation infections, surgical complication. It also affects the duration of hospitalization and the rate of mortality after surgeon. Therefore the assessment of the nutritional status of patients with chronic liver disease is extraordinary important. The purpose of this research aims to make assessment of nutritional status of Pre- and Post- Liver Transplantation in children with Biliary Atresia in Taiwan and, by reference of the assessment, try to find out the best way for nutritional treatment for the children with Biliary Atresia. Methods: Nutritional assessment include anthropometric, dietary record and bone mineral density (measure by DEXA) were made, Pre-Liver Transplantation and one year Post-Liver Transplantation, for 30 patients (Age-average: 3.6 years old) of biliary atresia with end-stage liver disease in NTUH. Results: Before transplantation, twenty-three patients (77%) were below the 25th percentile for body height. The body height z score was -1.45 before transplantation and -0.99 after; body height is significantly improved after transplantation (p＜0.05). Twenty-five patients (83%) were below the 25th percentile for body weight. The body weight z score was -1.48 before transplantation and -0.72 after, body weight is significantly improved after transplantation (p＜0.0001). Protein intake, when compares with DRI (Daily recommendation intake) were no difference (p=0.402). Energy intake, when compares with DRI were below and have significant low (p＜0.0001). The bone mineral density were low(p＜0.0001) and have great improvement after one year of the transplantation. In conclusion, before transplantation, children with biliary atresia have problem of severe malnutrition (especially energy intake), decrease of bone mineral density and physical retardation. However, the status of bone mineral density and physical retardation could have significant improvement in the first year of transplantation, but long-term nutrition cares for post-transplantation still need more follow-ups.