Related Experiment Videos
Growth following solid-organ transplantation
1Department of Pediatrics, SUNY at Stony Brook, Stony Brook, New York 11794-8111, USA. richard.fine@sunysb.edu
Insights
Achieving optimal adult height after pediatric solid-organ transplantation is crucial. Factors like younger age, good graft function, and minimizing corticosteroid use significantly improve growth outcomes in transplant recipients.
Area of Science:
- Pediatric Solid-Organ Transplantation
- Growth and Development Post-Transplant
- Immunosuppression Strategies
Background:
- Optimal final adult height is a key goal for pediatric solid-organ transplant (Tx) recipients.
- Limited data exist on growth outcomes except for kidney Tx.
- Growth is influenced by similar factors across kidney, liver, and heart recipients.
Purpose of the Study:
- To review factors impacting growth in pediatric solid-organ transplant recipients.
- To highlight the importance of achieving normal growth for quality of life.
- To discuss the role of immunosuppression in growth outcomes.
Main Methods:
- Literature review and synthesis of existing data on pediatric solid-organ Tx and growth.
- Analysis of factors including age, graft function, and immunosuppression.
- Comparison of growth patterns across different solid organs (kidney, liver, heart).
Main Results:
- Younger recipient age is associated with greater catch-up growth.
- Reduced graft function (e.g., lower GFR) correlates with poorer growth.
- Steroid withdrawal/reduction can improve growth but may increase rejection risk in kidney/liver Tx.
- Avoiding maintenance corticosteroids in infant heart Tx is linked to normal growth velocity.
Conclusions:
- Normal growth and attainment of adult height are achievable goals post-pediatric solid-organ Tx.
- Careful management of immunosuppression, particularly corticosteroids, is vital for optimizing growth.
- Focusing on quality-of-life issues, including growth, is increasingly important with improved survival rates.
Abstract:
One of the ultimate goals of successful transplantation (Tx) in pediatric solid-organ transplant recipients is the attainment of optimal final adult height. Except for kidney Tx there are limited data to address this issue. Remarkably similar factors impact on growth in pediatric kidney, liver, and heart recipients. Age is a primary factor, with younger recipients exhibiting the greatest immediate catch-up growth. Graft function is a significant contributory factor: a reduction in glomerular filtration rate (GFR) correlates with poor growth in kidney recipients, and the need for re-Tx is associated with impaired growth in liver recipients. The known adverse impact of corticosteroids on growth has led transplant physicians/surgeons to either modify the dose or attempt steroid withdrawal. In kidney and liver recipients this is associated with the development of acute rejection episodes. In infant heart transplant recipients the avoidance of maintenance corticosteroid immunosuppression is associated with normal growth velocity in the majority of recipients. With the marked improvement in patient and graft survival rates in pediatric solid-organ graft recipients, it is timely that the quality-of-life issues receive paramount attention. In children, normal growth following solid-organ Tx should be an achievable goal that results in normal final adult height.