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Factors influencing growth and final height after renal transplantation
A Ninik1, S J McTaggart, S Gulati
1Victorian Paediatric Renal Service, Royal Children's Hospital, Melbourne, Australia.
Insights
Pediatric renal transplant recipients often experience suboptimal growth. Key factors influencing final height include pre-transplant height, age at transplant, graft function, and immunosuppression. Optimizing these can improve post-transplant growth outcomes.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Growth and Development
Background:
- Chronic renal insufficiency frequently causes growth retardation in children and adolescents.
- Renal transplantation can lead to catch-up growth, but outcomes are often suboptimal.
- Understanding factors influencing post-transplant growth is crucial for improving long-term outcomes.
Purpose of the Study:
- To review factors influencing growth and final height in children and adolescents following renal transplantation.
- To identify predictors of growth and final height in a pediatric renal transplant cohort.
- To correlate clinical and laboratory parameters with growth outcomes post-transplantation.
Main Methods:
- Retrospective analysis of 85 pediatric renal transplant recipients (1985-1998).
- Exclusion of patients with early mortality or loss to follow-up; analysis focused on the most recent graft.
- Statistical analysis including univariate and multiple regression to identify predictors of growth (Ht-SDS and DeltaHt-SDS).
Main Results:
- Mean height standard deviation score (Ht-SDS) improved from -2.11 at transplantation to -1.50 at 7 years post-transplant.
- Cyclosporine dosage and graft function at specific time points correlated positively with growth.
- Pre-transplant height was a strong predictor of subsequent growth.
- Height at transplant, age at transplant, and final glomerular filtration rate were significant independent predictors of final height in older adolescents.
- Immunosuppressive regimen also significantly impacted growth.
Conclusions:
- Post-transplant growth in children is influenced by multiple factors, including pre-transplant status and graft-related parameters.
- Graft function, immunosuppression, and patient characteristics are critical for optimizing growth after renal transplantation.
- This study highlights the importance of considering these factors to improve final height in pediatric renal transplant recipients.
Abstract:
Growth retardation occurs commonly in children and adolescents with chronic renal insufficiency. While some children exhibit catch-up growth following renal transplantation, for many children growth remains sub-optimal. The aim of the current study was to review the factors influencing growth and final height following renal transplantation. Data from all children who had a renal transplant performed between 1985 and 1998 at the Royal Melbourne and Royal Children's Hospitals, Melbourne (n = 85), were examined retrospectively. Two children who died in the first year post-transplant and one patient lost to follow-up within 6 months of their transplant were excluded. Children with multiple grafts had only growth following their most recent graft analyzed. The mean height standard deviation score (Ht-SDS) at the time of transplantation was -2.11 (range: -5.05 to 0.27), improving to -1.50 (range: -3.67 to 1.27) at 7 yr post-transplant. On univariate analysis, the dose of cyclosporin at 6 months and at 1 and 3 yr, and the graft function at 1 yr, had a significant positive correlation with the change in Ht-SDS (DeltaHt-SDS) at each of those time-points post-transplant. At all time-points there was a strong correlation between pretransplant height and subsequent growth. A sub-group of children who were 16 yr of age or older at December 1999, and who were considered to have reached their final height, were examined to determine predictors of final height. Multiple regression analysis of clinical and laboratory parameters from the sub-group of patients > or = 16 yr of age showed that height at the time of transplant, age at the time of transplant, and final glomerular filtration rate, were significant independent predictors of growth (r2 = 0.82, p = 0.01). In addition, the immunosuppressive regimen at 1, 3, and 5 yr post-transplant had a significant effect on growth. This study confirms the importance of each of these factors for post-transplant growth.