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Growth after renal transplantation: an update
G Offner1, C Aschendorff, J Brodehl
1Kinderklinik, Medizinische Hochschule Hannover, Federal Republic of Germany.
Pediatric Nephrology (Berlin, Germany)
|July 1, 1991
Summary
Pediatric kidney transplant recipients experienced better growth with cyclosporine A (CyA) and low-dose prednisolone compared to azathioprine (Aza) and high-dose prednisolone. Final adult height was in the lower normal range, influenced by pre-transplant factors and graft function.
Area of Science:
- Pediatric Nephrology
- Transplantation Medicine
- Growth and Development
Background:
- Post-transplant growth is a critical outcome in pediatric kidney transplant recipients.
- Factors influencing growth include pre-transplant renal failure duration, disease type, and immunosuppressive therapy.
- Assessing final height and growth velocity is essential for evaluating transplant success.
Purpose of the Study:
- To analyze factors affecting post-transplant growth in children.
- To compare the impact of different immunosuppressive regimens on growth.
- To determine the influence of graft function on catch-up growth.
Main Methods:
- Analysis of 163 pediatric kidney transplant recipients.
- Evaluation of pre-transplant factors: chronic renal failure duration, congenital vs. acquired renal disease.
- Comparison of growth rates between cyclosporine A (CyA) + low-dose prednisolone and azathioprine (Aza) + high-dose prednisolone regimens.
- Assessment of growth in prepubertal children with varying graft function (glomerular filtration rate).
Main Results:
- Statural height at transplantation correlated with pre-transplant renal failure duration; congenital diseases showed greater retardation.
- Bone age retardation significantly correlated with growth retardation.
- CyA + low-dose prednisolone resulted in significantly better growth rates than Aza + high-dose prednisolone.
- Poor graft function (GFR < 40 ml/min/1.73 m2) inhibited catch-up growth in prepubertal children on CyA.
- Final height for 20 grown-up recipients was in the lower range of normal.
- Adult height was higher in the CyA group compared to the Aza group due to increased growth velocity.
Conclusions:
- Immunosuppressive regimen significantly impacts post-transplant growth velocity and final height in pediatric kidney transplant patients.
- Pre-transplant factors and graft function are crucial determinants of growth outcomes.
- Cyclosporine A-based immunosuppression appears more favorable for achieving better growth compared to azathioprine.