Abstract
ABSTRACT: A retrospective study evaluated posttrans-plant 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 catchup 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).
Similar content being viewed by others
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hokken-Koelega, A., Van Zaal, M., De Ridder, M. et al. Growth after Renal Transplantation in Prepubertal Children: Impact of Various Treatment Modalities. Pediatr Res 35, 367–371 (1994). https://doi.org/10.1203/00006450-199403000-00020
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1203/00006450-199403000-00020
This article is cited by
-
Clinical practice guideline for pediatric idiopathic nephrotic syndrome 2013: general therapy
Clinical and Experimental Nephrology (2015)
-
Growth hormone improves growth in pediatric renal transplant recipients—a systemic review and meta-analysis of randomized controlled trials
Pediatric Nephrology (2013)
-
Morbidities in Patients with Hypoplastic Left Heart Syndrome
Pediatric Cardiology (2004)
-
Long-term follow-up of renal transplantation in children: A 20-year experience at one kidney center in Japan
Clinical and Experimental Nephrology (1997)