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Growth after renal transplantation in prepubertal children: impact of various treatment modalities
A C Hokken-Koelega1, M A Van Zaal, M A de Ridder
1Department of Pediatrics, Sophia Children's Hospital/Erasmus University, Rotterdam, The Netherlands.
Insights
Most prepubertal children experience limited catch-up growth after renal transplantation (RTx). Optimizing immunosuppressive treatment, including alternate-day prednisone and cyclosporine, is key for better post-RTx growth outcomes.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Growth and Development
Background:
- Renal transplantation (RTx) is a critical treatment for children with end-stage renal disease.
- Post-transplant growth remains a significant challenge for prepubertal pediatric recipients.
- Understanding factors influencing growth is crucial for optimizing long-term outcomes.
Purpose of the Study:
- To evaluate posttransplant growth in prepubertal children during the first two years after RTx.
- To identify predictive factors influencing catch-up growth after RTx.
- To determine optimal immunosuppressive strategies for promoting growth.
Main Methods:
- Retrospective study of 70 prepubertal children post-RTx.
- Analysis of height standard deviation score changes over two years.
- Multiple regression analysis to identify predictive factors for growth.
Main Results:
- 70% of children had less than 0.5 SD increment in height over two years.
- Alternate-day prednisone positively influenced growth; high cumulative prednisone doses negatively impacted it.
- Azathioprine, compared to cyclosporine A, and persistently reduced GFR (<50 mL/min/1.73 m2) negatively influenced catch-up growth.
- Severe pre-RTx growth retardation did not result in complete catch-up growth.
Conclusions:
- Significant catch-up growth is uncommon in the first two years post-RTx for most prepubertal children.
- Optimizing pretransplant height is highly important.
- Strategies involving cyclosporine, minimal alternate-day prednisone, and maintaining GFR >50 mL/min/1.73 m2 may promote optimal post-RTx growth.
Abstract:
A retrospective study evaluated posttransplant growth of 70 prepubertal children during the first 2 y after renal transplantation (RTx). Immunosuppressive treatment consisted of prednisone administered either daily or on alternate days in combination with either azathioprine or cyclosporin A. The increment in height standard deviation score for chronologic age during the first 2 y after RTx was less than 0.5 SD for 70% of the study population. The predictive factors for posttransplant growth were determined by evaluating several factors and treatment modalities singly and simultaneously in a multiple regression analysis. Patients with the most severe growth retardation at RTx appeared to have the most pronounced growth spurt after RTx, but even they never had complete catch-up growth, and 2 y after RTx they were still shorter than those with less severe growth retardation at RTx. Alternate-day instead of daily prednisone administration had a significantly positive influence, whereas a high cumulative dose of prednisone, azathioprine instead of cyclosporin A therapy, and a persistently reduced GFR (GFR < 50 mL/min/1.73 m2) had a significantly negative influence on catch-up growth during the 2 y after RTx. Other factors, such as gender, chronologic and bone age at RTx, primary renal disease, duration of initial dialysis, repeat RTx, and target height SD score for chronologic age, whether evaluated singly or simultaneously with other significant factors, appeared to have no significant influence on post-RTx growth. Thus, 70% of the prepubertal children do not experience appreciable catch-up growth during the first 2 y after RTx. Optimization of pretransplant height appears very important. Immunosuppressive treatment with cyclosporin therapy in combination with a minimal dose of alternate-day prednisone would then result in optimal post-transplant growth, particularly if the GFR remains above 50 mL/min/1.73 m2).