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A Simplified Model for Heterotopic Heart Valve Transplantation in Rodents
Published on: September 21, 2021
Growth and skeletal maturation after pediatric cardiac transplantation
Adi Cohen1, Linda J Addonizio, Barney Softness
1Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Insights
Pediatric cardiac transplant recipients often experience delayed bone age and growth issues. Cyclosporin A and low BMI were linked to skeletal maturation delays post-transplant.
Area of Science:
- Pediatric Endocrinology
- Cardiology
- Transplantation Medicine
Background:
- Cardiac transplantation is a life-saving procedure for children with end-stage heart disease.
- Concerns exist regarding the long-term effects of transplantation on growth and skeletal development in pediatric populations.
Purpose of the Study:
- To investigate the impact of cardiac transplantation on skeletal maturation and linear growth in pediatric recipients.
- To identify factors associated with delayed bone age and growth retardation following heart transplantation.
Main Methods:
- Retrospective analysis of bone age determinations and growth parameters in 86 pediatric cardiac transplant recipients (1984-1998).
- Evaluation of pre-transplantation diagnoses, age at transplantation, immunosuppressant levels (cyclosporin A), and body mass index (BMI).
Main Results:
- 38.5% of patients had delayed bone age at transplantation; 29% experienced significant delays (>36 months) post-transplant.
- Younger recipients (
- High cyclosporin A levels and low BMI were significantly associated with delayed bone age.
Conclusions:
- Cardiac transplantation can adversely affect skeletal maturation and linear growth in children.
- Further research is needed to understand the mechanisms behind growth disturbances and skeletal delays in this patient group.
Abstract:
To examine the effects of cardiac transplantation on skeletal maturation and linear growth, we retrospectively evaluated annual bone age determinations and growth parameters of pediatric cardiac transplant recipients followed at our center. Included in the analysis were records of 86 patients (32 females) who had received a cardiac transplant at our institution between 1984 and 1998. Bone age delay of > or =12 months was apparent in 38.5% at the time of transplantation. At some point in their post-transplant course, 23 patients (29%) had one or more bone age measurements that were > or =36 months delayed with respect to chronological age. Children transplanted before age seven and those with a pretransplantation diagnosis of cardiomyopathy experienced the most significant decrement in skeletal maturation after transplantation. High cyclosporin A levels and low body mass index were the only parameters found to be associated with delayed bone age. Although the majority of children grew at a normal rate after transplantation, height Z scores and height age were adversely affected regardless of the type of heart disease or the age at transplantation. The pathogenesis of both delayed skeletal maturation and growth retardation in this population warrant further investigation.
