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Differences in anthropometric parameters and the IFG-I-IGFBP3 axis between liver and renal transplant children
T Pasqualini1, J R Ferraris, H Jasper
1Departamento de Pediatría, Hospital Italiano de Buenos Aires, Argentina.
Insights
Children who received liver transplants experienced improved growth, unlike those with kidney transplants. This difference may stem from varying graft function and steroid use post-transplantation.
Area of Science:
- Pediatric Endocrinology
- Transplantation Medicine
- Pediatric Nephrology
Background:
- Growth patterns can be significantly altered in children following liver or renal transplantation.
- Understanding these differences is crucial for optimizing post-transplant care.
Purpose of the Study:
- To compare graft function, linear growth, and hormonal profiles (IGF-I, IGFBP3) in pediatric liver versus renal transplant recipients.
- To investigate the impact of immunosuppression, particularly corticosteroid dosage, on growth outcomes.
Main Methods:
- A cohort of 15 liver and 17 renal transplant patients were followed for 4-6 years.
- Graft function (creatinine clearance), linear growth (height SDS), and serum concentrations of insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP3) were assessed.
Main Results:
- Liver transplant recipients showed improved height SDS post-transplant, while renal recipients did not.
- Renal graft function declined over time, and immunosuppressive corticosteroid dosage remained higher in renal recipients compared to liver recipients.
- Liver transplant recipients exhibited higher IGF-I and a higher IGF-I/IGFBP3 molar ratio post-transplant.
Conclusions:
- Catch-up growth is achievable after pediatric liver transplantation but not typically after renal transplantation.
- Reduced renal graft function and sustained corticosteroid therapy may impede growth in renal transplant recipients.
- Future research should focus on minimizing or replacing steroid therapy in pediatric renal transplant patients without compromising graft function.
Background:
Growth can be differently altered after liver and renal transplantation (Tx) in childhood.
Methods:
We compared graft function, linear growth, immunosuppression and serum IGF-I (RIA) and IGFBP3 (IRMA) concentrations in 15 liver (5.6+/-1.1 years old) and 17 renal (7.4+/-0.1 years old) Tx patients who were followed for 4-6 years.
Results:
Graft function was normal post-liver Tx, although in renal recipients creatinine clearance decreased significantly during follow-up. Liver Tx children presented an increase in mean height of 0.92+/-0.2 SDS (P<0.01) beyond the 2nd year post-Tx, although in renal Tx patients height SDS did not improve. Immunosuppressive corticoid dosage could be decreased and discontinued in liver Tx patients, while in renal recipients it was maintained between 0.18+/-0.01 and 0.16+/-0.02 mg/kg/day. At 3.7+/-0.4 years post Tx, liver Tx patients presented higher mean serum IGF-I level, lower mean serum IGFBP3 value, leading to a higher mean IGF-I/IGFBP3 molar ratio, P<0.001.
Conclusions:
We found that while catch up growth coud be achieved after liver Tx, height SDS did not improve after renal Tx. This may be related to a reduced renal graft function and/or to differences in immunosuppressive corticoid dosage. In children with renal transplants a challenge for the future will reside in making it possible to substitute steroid therapy without altering graft function.