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Growth in children following kidney transplantation
R S Fennell1, M Moles, A Iravani
1Department of Pediatrics, University of Florida, Gainesville 32610-0296.
Insights
Pediatric kidney transplant recipients may experience growth challenges. Early transplantation before age 7 and good initial kidney function promote catch-up growth, while declining renal function negatively impacts height outcomes.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Growth and Development
Background:
- Kidney transplantation is a life-saving intervention for children with end-stage renal disease.
- Post-transplant growth is a critical indicator of long-term health and quality of life in pediatric recipients.
- Factors influencing growth post-kidney transplant require further elucidation to optimize patient outcomes.
Purpose of the Study:
- To analyze growth patterns in children after kidney transplantation.
- To identify key variables affecting height standard deviation scores post-transplant.
- To understand differential growth responses based on patient characteristics and treatment regimens.
Main Methods:
- Utilized generalized growth curve multivariate analysis on data from 128 pediatric kidney transplant recipients.
- Dependent variable: height standard deviation score.
- Independent variables included time since transplant, prednisone dosage, and creatinine clearance, with comparisons across demographic and clinical subgroups.
Main Results:
- Height standard deviation scores generally trended negatively post-transplantation.
- Children transplanted before age 7 with initial allograft function >60 ml/min/1.73 m2 showed "catch-up" growth.
- Decreased prednisone dosage improved height scores in males (not females); decreased renal function worsened height scores, particularly in black children, those <7 years, and males.
Conclusions:
- Early kidney transplantation and optimal initial allograft function are crucial for promoting catch-up growth in pediatric recipients.
- Renal function decline significantly impacts growth, with varying effects across different demographic groups.
- Sex-specific responses to immunosuppression (prednisone) and the impact of renal function on growth warrant further investigation.
Abstract:
Growth was assessed in children following 128 separate kidney transplants using a generalized growth curve multivariate analysis. The height standard deviation score was the dependent variable. Time since transplant, prednisone dosage, and creatinine clearance were the independent variables. For the purposes of comparison patients were grouped according to sex, race, age at transplantation, initial allograft function, acute rejection episodes and the use of cyclosporin A. Patient's height standard deviation scores tended to increase negatively after transplantation. However, children who received transplants before their 7th birthday, with initial allograft function greater than 60 ml/min per 1.73 m2, exhibited "catch-up" growth. Height standard deviation scores positively improved in males but not in females, as prednisone dosage was decreased. Height standard deviation scores became more negative as renal function decreased after transplantation. Changes in renal function produced the greatest effect upon height in black children, children less than 7 years, and males.