Bone Mineral Density and Growth in Children Having Undergone Liver Transplantation With Corticosteroid‐Free Immunosuppressive Protocol
Bibliographic record
Abstract
Background: Children post–liver transplantation (post‐LTX) are at risk of growth delay and decreased bone mineral density (BMD) secondary to corticosteroid (CS) therapy and suboptimal intake of nutrients important for bone health. The pediatric LTX program at Stollery Children's Hospital introduced a CS‐free LTX regimen in 2003. This retrospective study investigated whether the implementation of a CS‐free protocol resulted in improvements in BMD (dual x‐ray absorptiometry) and growth following LTX. Methods: A retrospective chart review of all children undergoing LTX was conducted. The parameters included repeated measures of anthropometric (weight, weight z score, height, height z score), BMD/bone mineral content (BMC), laboratory variables, graft function (number/severity of rejection), and CS therapy (dose, duration). Results: A total of 39 patients met study inclusion (20 male; n = 28 on CS; n = 11 CS‐free). Mean duration of follow‐up was 5.5 ± 3.3 years. The mean weight and height z scores were −0.31 ± 0.14 (CS) and 0.22 ± 0.23 (CS‐free; P = .09) and −0.71 ± 0.13 (CS) and 0.23 ± 0.22 (CS‐free; P = .002), respectively. Lumbar and whole‐body BMD z score less than −2 were present in 15% and 8% of the cohort, respectively. There were no significant differences between CS and CS‐free in lumbar BMC (22.2 ± 1.4 and 23.4 ± 2.02 g; P = .165) and lumbar BMD (0.57 ± 0.02 and 0.80 ± 0.22 g/cm2; P = .152), respectively. Lumbar BMC (r2 = 0.89, P < .05) and whole‐body BMC (r2 = 0.93, P < .05) were inversely related to CS dose >0.2 mg/kg/d and positively related to bone age (P < .01). Conclusion: CS therapy in children post‐LTX is associated with reduced BMC and delayed linear growth. Understanding the clinical and nutrition factors influencing bone health is important to optimizing growth and bone health in children post‐LTX.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".