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Growth following solid-organ transplantation.

Richard N Fine¹

¹Department of Pediatrics, SUNY at Stony Brook, Stony Brook, New York 11794-8111, USA. richard.fine@sunysb.edu

Pediatric Transplantation

|March 22, 2002

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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.

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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.