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Published on: April 12, 2021
Determinants of growth after kidney transplantation in prepubertal children
Julia Grohs1, Rainer-Maria Rebling1, Kerstin Froede1
1Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Insights
Pediatric kidney transplant recipients experience catch-up growth, primarily from trunk and leg length improvements. Pre-transplant growth hormone (GH) therapy and steroid exposure significantly impact post-transplant growth outcomes.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth and Development
Background:
- Short stature is a common complication following pediatric kidney transplantation (KT).
- The impact of transplantation type and prior recombinant human growth hormone (GH) treatment on post-transplant growth remains unclear.
Purpose of the Study:
- To investigate factors influencing post-transplant growth in prepubertal pediatric kidney transplant recipients.
- To analyze the effects of transplantation type and pre-transplant GH treatment on body dimensions and proportions.
Main Methods:
- Prospective study of 148 prepubertal patients in the CKD Growth and Development study.
- Median follow-up of 5.0 years, assessing body height, leg length, sitting height, and sitting height index.
- Linear mixed-effects models used to identify predictors of body dimensions.
Main Results:
- Pre-transplant patients exhibited disproportionate short stature (reduced height, sitting height, leg length; increased sitting height index).
- Catch-up growth involved trunk length in younger children (<4 years) and leg length in older children, normalizing proportions before puberty.
- Pre-transplant GH use, congenital CKD, birth parameters, parental height, time post-KT, steroid exposure, and transplant function were associated with growth.
- Adjusted analysis negated apparent superior growth with living donor KT, highlighting confounder influence.
Conclusions:
- Post-KT catch-up growth is driven by stimulated trunk and leg growth, varying by age.
- Pre-transplant growth hormone (GH) use and steroid exposure are key potentially modifiable factors for improved growth outcomes.
- Transplant function also plays a role in achieving optimal growth post-kidney transplantation.
Background:
Short stature is a frequent complication after pediatric kidney transplantation (KT). Whether the type of transplantation and prior treatment with recombinant human growth hormone (GH) affects post-transplant growth, is unclear.
Methods:
Body height, leg length, sitting height, and sitting height index (as a measure of body proportions) were prospectively investigated in 148 prepubertal patients enrolled in the CKD Growth and Development study with a median follow-up of 5.0 years. We used linear mixed-effects models to identify predictors for body dimensions.
Results:
Pre-transplant Z scores for height (- 2.18), sitting height (- 1.37), and leg length (- 2.30) were reduced, and sitting height index (1.59) was increased compared to healthy children, indicating disproportionate short stature. Catch-up growth in children aged less than 4 years was mainly due to stimulated trunk length, and in older children to improved leg length, resulting in normalization of body height and proportions before puberty in the majority of patients. Use of GH in the pre-transplant period, congenital CKD, birth parameters, parental height, time after KT, steroid exposure, and transplant function were significantly associated with growth outcome. Although, unadjusted growth data suggested superior post-transplant growth after (pre-emptive) living donor KT, this was no longer true after adjusting for the abovementioned confounders.
Conclusions:
Catch-up growth after KT is mainly due to stimulated trunk growth in young children (< 4 years) and improved leg growth in older children. Beside transplant function, steroid exposure and use of GH in the pre-transplant period are the main potentially modifiable factors associated with better growth outcome.
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