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Long-term follow-up of growth in children post-transplantation
1Department of Pediatrics, State University of New York, Health Science Center at Brooklyn.
Insights
Pediatric kidney transplant recipients showed improved growth post-transplantation, with age at transplant and initial height deficit being key factors. Children over six with growth retardation are unlikely to catch up after a successful transplant.
Area of Science:
- Pediatric Nephrology
- Transplant Medicine
- Growth and Development
Background:
- Improving graft survival in pediatric kidney transplantation necessitates a focus on post-transplant growth.
- Longitudinal growth tracking is crucial for assessing outcomes in pediatric transplant recipients.
Purpose of the Study:
- To analyze growth patterns in pediatric kidney transplant recipients over a three-year period.
- To identify factors influencing growth post-transplantation in children.
Main Methods:
- Utilized data from the North American Pediatric Renal Transplant Cooperative Study registry.
- Analyzed growth data from 412 patients with functioning grafts for at least three years.
- Assessed the impact of various factors including donor source, age, and initial height deficit.
Main Results:
- The mean growth deficit was -2.46, with a significant change in Z score (0.16, P < 0.01) at three years.
- Age at transplant and original height deficit were significant predictors of post-transplant growth.
- Children transplanted over the age of six with pre-existing growth retardation showed limited catch-up growth.
Conclusions:
- While overall growth improves, significant deficits can persist in pediatric kidney transplant recipients.
- Early age at transplant and a smaller initial height deficit are associated with better growth outcomes.
- Interventions for growth retardation should be considered prior to or early in the transplant process, especially for older children.
Abstract:
With improving graft survival, growth post-transplantation, demands increasing attention from pediatric transplant physicians. As our data base matures, the North American Pediatric Renal Transplant Cooperative Study is able to track growth patterns longitudinally. Of 2086 patients enrolled in the registry, 412 patients have had a functioning graft for at least three years. The mean growth deficit for this group was -2.46 and the change in Z score at three years was 0.16 (P < 0.01). Of various factors that could conceivably impact on growth post-transplantation such as donor source, race, number of transplants, and immunosuppressive therapy, only age at transplant and the original height deficit are significant. Most growth retarded children over the age of six years are unlikely to exhibit accelerated growth post-transplantation.