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. 2024 Sep;38(9):e15455.
doi: 10.1111/ctr.15455.

Sarcopenia in Children Post Liver Transplant: Development of a Home-Based Video Program to Support Muscle Strength and Function-A Pre-Post Controlled Pilot Study

Amber Hager  1 , Normand Boule  2 , Lesley Pritchard  3 , Sandra Hodgetts  4 , Michelle Noga  5   6 , Yuxin Guo  1 , Vera Mazurak  1 , Justin Grenier  5 , Richard Thompson  5 , Susan M Gilmour  6   7 , Diana R Mager  1   6
Affiliations

Sarcopenia in Children Post Liver Transplant: Development of a Home-Based Video Program to Support Muscle Strength and Function-A Pre-Post Controlled Pilot Study

Amber Hager et al. Clin Transplant. 2024 Sep.

Abstract

Introduction: Sarcopenia is common in children after liver transplantation (LTx). Resistance training (RT) may be effective in combating sarcopenia.

Objectives: The purpose of the study was to test the feasibility and impact of a 12-week RT program on skeletal muscle mass (SMM), muscle strength, physical performance (PP), and child-parent perspectives about RT.

Methods: Children (6-18 years) post-LTx and healthy controls (HC) underwent progressive RT using resistance bands. SMM and adipose tissue (MRI: abdomen and thigh), muscle strength (handgrip, push-ups, sit-to-stand), and PP (6-minute walk test [6MWT], timed-up-and-down-stair test [TUDS]) were measured before and after 12-weeks of RT.

Results: Ten children post-LTx (11.9 ± 3.5 years) and 13 HC (11.7 ± 3.9 years) participated. LTx children significantly increased abdominal SM-index (+4.6% LTx vs. a -2.7% HC; p = 0.01) and decreased visceral adipose tissue-index (-18% LTx vs. -0.8% HC; p = 0.04) compared to HC. No thigh SMI changes were noted. Significant increases in 6MWT distance (LTx; p = 0.04), number of push-ups (p = 0.04), and greater reduction times for TUDS (-10.6% vs. +1.7%; p = 0.05) occurred after 12 weeks. Higher thigh muscle-fat content was associated with worse physical performance. These results were impacted by adherence (≥75% vs. <75%) and family engagement.

Conclusions: RT in children post-LTx is feasible and effective. RT in children post-LTx may alleviate adverse outcomes associated with sarcopenia.

Keywords: children; feasibility; liver transplant; resistance exercise; sarcopenia.

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References

    1. P. H. Ooi, A. Hager, V. C. Mazurak, et al., “Sarcopenia in Chronic Liver Disease: Impact on Outcomes,” Liver Transplantation 25, no. 9 (2019): 1422–1438.
    1. P. H. Ooi, V. C. Mazurak, K. Siminoski, et al., “Deficits in Muscle Strength and Physical Performance Influence Physical Activity in Sarcopenic Children After Liver Transplantation,” Liver Transplantation 26, no. 4 (2020): 537–548.
    1. D. R. Mager, A. Hager, P. H. Ooi, K. Siminoski, S. M. Gilmour, and J. Y. K. Yap, “Persistence of Sarcopenia After Pediatric Liver Transplantation Is Associated With Poorer Growth and Recurrent Hospital Admissions,” JPEN Journal of Parenteral and Enteral Nutrition 43, no. 2 (2019): 271–280.
    1. P. H. Ooi, V. C. Mazurak, R. Bhargava, et al., “Myopenia and Reduced Subcutaneous Adiposity in Children With Liver Disease Are Associated With Adverse Outcomes,” JPEN Journal of Parenteral and Enteral Nutrition 45, no. 5 (2021): 961–972.
    1. M. D. Peterson, A. Sen, and P. M. Gordon, “Influence of Resistance Exercise on Lean Body Mass in Aging Adults: A Meta‐Analysis,” Medicine and Science in Sports and Exercise 43, no. 2 (2011): 249–258.

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