Related Experiment Videos
Growth after renal transplantation in infancy or early childhood
Erik Qvist1, Eino Marttinen, Kai Rönnholm
1Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Finland. erik.qvist@helsinki.fi
Insights
Pediatric kidney transplant recipients under 5 often achieve catch-up growth with alternate-day steroids. Initial height deficit, not age, predicts growth outcomes in these young transplant patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Growth and Development
Background:
- Children undergoing kidney transplantation (TX) often experience growth impairment.
- Optimizing growth post-transplant is crucial for long-term outcomes.
Purpose of the Study:
- To investigate growth, bone age, and renal function in children under 5 years old up to 7 years after kidney TX.
- To evaluate the impact of alternate-day corticosteroid treatment on catch-up growth.
Main Methods:
- Retrospective analysis of 41 children under 5 years at kidney TX.
- Assessment of growth (height standard deviation score - hSDS), bone age, and glomerular filtration rate (GFR).
- Comparison of outcomes with and without growth hormone (GH) treatment.
Main Results:
- 81% of children without GH treatment showed catch-up growth.
- Children aged 2-5 years significantly improved their hSDS (P<0.0001).
- Initial height deficit strongly predicted catch-up growth (r=-0.80, P=0.0002).
- GFR at 5 years post-TX correlated with subsequent growth rate (r=0.58, P=0.01).
- All children receiving GH treatment experienced catch-up growth, with significant hSDS improvement (P<0.0001).
Conclusions:
- Triple immunosuppression with alternate-day steroids supports catch-up growth in most pediatric kidney transplant recipients.
- The degree of stunting at TX is a better predictor of growth than chronological age in children under 5.
- Growth hormone treatment further enhances growth outcomes in this population.
Abstract:
Forty-one children <5 years of age at kidney transplantation (TX) were investigated for growth, bone age, and renal function up to 7 years ( n=26) after TX. All children received triple immunosuppression, including alternate-day corticosteroid treatment. Catch-up growth was seen in 81% of 30 children without growth hormone (GH) treatment. Children <2 years of age without GH had a mean height standard deviation score (hSDS) of -1.1+/-0.8 at TX and -1.1+/-0.5 at 7 years; children between 2 and 5 years improved their hSDS from -1.9+/-0.9 to -0.4+/-0.8 ( P<0.0001). The hSDS at TX correlated inversely with the DeltahSDS from TX to 7 years ( r=-0.80, P=0.0002). Glomerular filtrations rate (GFR) at 5 years post TX correlated with the subsequent growth rate from 5 to 7 years TX ( r=0.58, P=0.01). Catch-up growth was seen in all 11 children receiving GH. Their mean hSDS improved from -2.5+/-0.9 to -1.1+/-0.9 ( P<0.0001). In the majority of children receiving a kidney graft in early life, triple immunosuppression with alternate-day steroids can ensure catch-up growth. In children <5 years of age at TX, growth is predicted better by the degree of stunting than by age.