Linear growth in pediatric kidney transplant recipients

Growth impairment is a major concern in children with chronic kidney disease (CKD). Over the past two decades, recombinant human growth hormone (rhGH) has significantly improved linear growth in this population. Current recommendations support rhGH treatment in children with CKD who have a height below the 3rd percentile or reduced height velocity for age. Following kidney transplantation (KTx), rhGH, is usually deferred during the first post-transplant year until lack of spontaneous catch-up growth has been established. This study aimed to evaluate post-transplant growth in pediatric kidney transplant recipients and to examine its association with key demographic and clinical factors.

This study included all pediatric patients with kidney failure, who underwent KTx, at Shaare Zedek medical center, between January 2013 and December 2023. Demographic, clinical and laboratory data were retrieved from medical records.

A total of 62 patients were included. Mean height standard deviation score (SDS) improved from - 2.08 two years pre-KTx to - 1.6 two years post-KTx. Most growth gain occurred in the first-year post-KTx. Use of rhGH was associated with significant improvement in linear growth. Preemptive transplantation and parental height were significantly associated with better growth outcomes. Need for rhGH before transplantation was associated with lower height SDS at all time points, although these patients demonstrated a similar degree of improvement over time.

Preemptive transplantation was associated with improved linear growth. Ongoing growth monitoring after KTx may enable early identification of suboptimal growth and timely reintroduction of rhGH treatment.