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Research Snapshot Theater: GI - Nutrition, Adult and Pediatric

Growth in Children With Biliary Atresia After Liver Transplant

Monday, March 23, 2026
9:00 AM - 10:00 AM Central Time
Location: Connections Central - RST 04
  • NK

    Nicole Knebusch, RD

    Texas Children's Hospital, Texas, GTM

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • MV

    Manpreet A. Virk, MD

    Assistant Professor
    Baylor College of Medicine and Texas Children's Hospital, Texas

    Disclosure information not submitted.

  • MD

    Moreshwar S. Desai, MD

    Associate Professor
    Baylor College of Medicine/ Texas Children's Hospital, Texas

    Disclosure information not submitted.

  • Marwa Mansour, MD

    Texas

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • SB

    Stacey A. Beer, MPH, RD, CCTD

    Instructor
    Baylor College of Medicine and Texas Children's Hospital, Texas

    Disclosure information not submitted.

  • BP

    Brittany Pearo, RD, CSP, LDN, CCTD

    Clinical Dietitian
    Department of Clinical Nutrition Services, Texas Children’s Hospital, Texas

    Disclosure information not submitted.

  • kF

    kelby A. Fuller, MPAP, PA-C

    Instructor
    Baylor College of Medicine and Texas Children's Hospital, Texas

    Disclosure information not submitted.

  • TF

    Thomas Fogarty, MD, FAAP

    Assistant Professor
    Baylor College of Medicine/ Texas Children's Hospital, Texas

    Disclosure information not submitted.

  • JG

    John Goss, MD

    Professor
    Baylor College of Medicine and Texas Children's Hospital, Texas

    Disclosure information not submitted.

  • FS

    Fernando Stein, MD, FCCM

    Professor
    Baylor College of Medicine and Texas Children's Hospital, Texas

    Disclosure information not submitted.

  • JC

    Jorge Coss-Bu, MD, FCCM

    Professor
    Baylor College of Medicine/ Texas Children's Hospital, Texas

    Disclosure information not submitted.

Introduction: Biliary atresia (BA) is a progressive obstructive disease of the biliary tree, causing severe cholestasis that leads to cirrhosis and the need for a liver transplant (LT). Failure to thrive and malnutrition are common in these children. We evaluated children's BA growth trajectory for one year after LT. We hypothesize that the growth trajectory one year after LT is associated with the patient’s age at the time of transplant.


Methods: Retrospective cohort study of children < 18 years of age with BA admitted to Texas Children’s Hospital PICU (index) after LT from 2011 to 2024. Patient demographics were collected. Nutritional status was evaluated by WHO ( < 2 years) and CDC (>2 years) growth charts. Weight for age (WFA), height for age (HFA), and weight for length or BMI for age (BMI/A) z-scores were obtained at time of LT, and at 3 months intervals up to 12 months and compared in children < 1 yr. vs. >1yr. Malnutrition defined as z-scores <-2 and classified as underweight, stunting, and acute malnutrition. Analysis by T-test.


Results: A total of 138 children were enrolled, with a median (IQR) age of 14 (9-14) mos.; weight, 10 (8-14) kg; height, 75 (67-92) cm; PELD score, 26 (15-30), duration of mechanical ventilation, 1 (0.5-20) days, ICU length of stay (LOS), 7 (3-26) days, hospital LOS, 24 (9-63) days, and mortality at 1 yr. of 4.35% (n=6). The z-scores for WFA, HFA, and BMI/A at LT were: -0.21±1.43 (SD), -0.80±1.97, and 0.68±1.16, for a malnutrition prevalence of 10%, 22%, and 1.45%, respectively; while at 12 mos. after LT were: 0.26±1.12, -0.83±1.34, and 0.94±1.05, for a malnutrition prevalence of 4.76%, 21%, and 1.60%, respectively. The z-score comparison at the time of LT for < 1 yr. (n=58) vs. >1 yr. (n=80) did not show statistical significance for WFA, HFA, and BMI/A. The z-score comparison at 12 mos. for < 1 yr. (n=52) vs. >1 yr. (n=74) was: WFA, 0.32±0.94 vs. 0.22±1.23, (p=0.61), HFA, -1.14±1.19 vs. -0.61±1.40, (p=0.029), and 1.19±1.06 vs. 0.76±1.01, (p=0.023).


Conclusions: Malnutrition was present in children with biliary atresia at the time of LT, with stunting being the most prevalent at 22%. At 12 months after LT, stunting remained the most prevalent type of malnutrition with 21%, and younger children had significantly lower HFA and higher BMI/A z scores compared to older children.