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Growth and sexual maturation in children after kidney transplantation
Insights
Pediatric kidney transplant recipients on prednisone showed improved growth post-transplant. However, pubertal growth significantly impacts final adult height more than pre-transplant growth.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth and Development
Background:
- Long-term outcomes of pediatric renal transplantation are crucial for patient well-being.
- Prednisone therapy is common but can affect growth and sexual maturation.
- Assessing linear growth and pubertal development is essential for pediatric allograft recipients.
Purpose of the Study:
- To evaluate linear growth and sexual maturation in pediatric renal allograft recipients on prednisone.
- To determine the impact of pre-pubertal and pubertal growth on final adult height.
- To analyze growth velocity and pubertal timing in this patient cohort.
Main Methods:
- Longitudinal assessment of linear growth and sexual maturation in 68 pediatric renal allograft recipients.
- Analysis of growth during prepubertal and pubertal periods.
- Comparison of growth parameters with chronological and bone age.
Main Results:
- Many children had short stature at transplantation, but over half achieved normal height increments post-transplant.
- Pubertal onset occurred within the normal range, but height deficit persisted.
- While many children had normal height velocity during puberty, a significant proportion did not reach an average adult height.
Conclusions:
- Poor pre-transplant growth significantly influences adult height in pediatric renal allograft recipients.
- Loss of growth potential during pubertal development appears to be a critical factor affecting final adult height.
- Optimizing growth during puberty is essential for improving adult height outcomes in these patients.
Abstract:
Linear growth and sexual maturation were assessed in 68 long-term pediatric renal allograft recipients (43 boys) receiving daily or alternate-day prednisone therapy. Growth was analyzed both during the prepubertal period and during puberty. Height at transplantation was greater than 2 SD below the mean in 34.2% of prepubertal children. After the first posttransplant year, 59.2% of the prepubertal children had a normal height increment (greater than 4.8 cm/yr). Onset of puberty was recorded at a chronologic age of 14.6 +/- 1.9 years in boys and 13.3 +/- 1.9 years in girls. Height at onset of puberty related to chronologic age was -2.4 +/- 1.3 SD. Height velocity during puberty was within normal limits in 62.5% of the children. No significant difference in pubertal growth was detected in patients who had received transplants before and after the onset of puberty. Duration of pubertal development was within normal limits. In girls, menarche was achieved at a mean chronologic age of 15.9 years and bone age 12.9 years. Adult height was attained at an average age of 20.3 years in boys and 18.7 years in girls. Overall, one third of the children attained an adult height greater than 2 SD below the mean. Our data indicate that although poor growth before kidney transplantation has a great influence on adult height, the loss of growth potential during pubertal development seems even more important.
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