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Published on: September 20, 2020
Effects of growth hormone therapy in children after cardiac transplantation
Seema Mital1, Aleza Andron, Jacqueline M Lamour
1Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York, USA. sm364@columbia.edu
Insights
Growth hormone (GH) therapy effectively treats growth failure in pediatric heart transplant recipients. GH improved growth and cardiac function, with some reversible cardiovascular changes observed post-therapy.
Area of Science:
- Pediatric Cardiology
- Endocrinology
- Transplantation Medicine
Background:
- Growth hormone (GH) is a standard treatment for growth failure in children.
- The safety and efficacy of GH in pediatric cardiac transplant recipients were previously unknown.
Purpose of the Study:
- To evaluate the growth and cardiovascular effects of GH in children experiencing growth failure post-cardiac transplantation.
Main Methods:
- A cohort of 10 pediatric cardiac transplant recipients receiving GH between 1994 and 2004 were monitored for 2 years.
- Growth, cardiac function (including left ventricular mass and volume), hemodynamics, and rejection rates were assessed.
- An age-matched control group of 8 heart transplant recipients without GH therapy was included.
Main Results:
- GH significantly increased growth velocity (GV) from 2.5 to 8.6 cm/year.
- Left ventricular (LV) mass, LV volume, and cardiac index increased significantly during GH therapy (p < 0.05).
- Cardiovascular changes were partially reversible after GH discontinuation, with no increase in rejection frequency.
Conclusions:
- GH is safe and effective for treating growth failure in pediatric cardiac transplant survivors.
- GH therapy induces reversible increases in LV mass, volume, and cardiac output.
- Further research is needed to understand the long-term implications of these cardiovascular changes.
Background:
Growth hormone (GH) is used to treat growth failure in children with GH deficiency. The safety and efficacy of GH after pediatric cardiac transplantation is not known. The objective of this study was to evaluate growth and cardiovascular effects of GH in children with growth failure after cardiac transplantation.
Methods:
Pediatric cardiac transplant recipients who received GH from 1994 to 2004 were evaluated. Growth, cardiac function, hemodynamics and rejection frequency were serially monitored for 2 years before, during and after GH. Eight age-matched heart transplant recipients undergoing a natural growth spurt were evaluated as controls.
Results:
The mean age of subjects at initiation of GH was 13 +/- 3 years (mean duration 2.5 +/- 1 years, n = 10), of whom 3 were GH-deficient. Growth velocity (GV) increased from 2.5 +/- 2 to 8.6 +/- 3 cm/year with GH. There was an increase in left ventricular (LV) shortening fraction (SF; 37 +/- 1% to 41 +/- 1%), LV mass (93 +/- 11 to 118 +/- 15 g/m2), LV volume (138 +/- 14 to 188 +/- 21 ml/m2) and cardiac index (3.1 +/- 0.7 to 4.1 +/- 0.5 liters/min/m2) during GH therapy (p < 0.05). After discontinuation of GH, SF, cardiac index and LV mass returned to normal, but LV volume did not. In control patients, LV volume increased without an increase in SF or mass. Rejection frequency did not change in either group. There were no adverse events related to GH.
Conclusions:
GH is safe and effective in treating growth failure in children after cardiac transplantation. GH therapy is associated with an increase in LV mass, volume and cardiac output. These changes are partially reversible after discontinuation of GH. The mechanisms and long-term consequences of these changes require further investigation.
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