A LONGITUDINAL-STUDY OF THE NATURAL-HISTORY OF GROWTH POSTTRANSPLANTATION

We have evaluated 587 patients with a functioning renal allograft for at least 54 months in whom baseline and continuous bi-annual height me asurements were available. All height data were converted into SD scor e (SDS) or Z-score using normative tables. The results obtained in the se patients were compared to our previous data collected at two years (N = 300) and three years (N = 412) post-transplantation. The demograp hy of the study groups in the three time periods was similar. The heig ht deficit in the first study was -2.41; it was -2.46 at the end of th e second study period and was -2.29 at the end of the third study peri od. Children in the first study period had an improvement in height SD S (Delta Z) of +0.18, of +0.16 in the second period, and of +0.11 at t he end of the third study period. When improvement in height so was ev aluated by donor source, no differences were noted between living rela ted and cadaver donor transplants. Analysis of height SDS by race reve aled that, whereas for Caucasian children a steady improvement of 0.18 was noted during both second and third study periods, there was actua l deceleration of growth for the African-American and Hispanic childre n at the end of the third study period (P < 0.02). Multivariate analys is showed that only initial height deficit and recipient age were inde pendent predictors of improved height post-transplantation. Catch up g rowth, defined as an improvement of 1 SDS, was seen only in those with the greatest deficit or in children 0 to 1 year of age. Overall, catc h up growth was seen in only 47% of 2 to 5 year olds. For children ove r the age of six years who form 72% of the total study cohort, little catch up growth was noted. Our long-term studies reveal that in the fi rst five years post-transplantation, when renal function is still stab le, height acceleration does not occur in most of the children over th e age of six years, and alternative strategies are necessary to improv e the quality of life of these children.