DIFFERENCES IN LINEAR GROWTH AND CORTISOL PRODUCTION BETWEEN LIVER AND RENAL-TRANSPLANT RECIPIENTS ON SIMILAR IMMUNOSUPPRESSION

Linear growth is more often impaired after Liver than after renal tran splantation (Tx) in childhood. As similar triple immunosuppression was used in our liver and renal transplant recipients, we were able to Co mpare growth and endocrine function between 19 prepubertal liver and 3 5 renal transplant recipients. There is no significant differences in median age, weight-for-height index, or height standard deviation scor e at Tx. Seventy-eight percent of the liver Tx patients, but only 7% o f the renal Tx patients, were below the normal range for height 3 year s after Tx. Graft function was good in both liver and renal transplant recipients 3 years after Tx. There was no significant difference in g rowth hormone secretion, serum insulin-like growth factor (IGF)-I, and IGF-binding protein-3 levels, or in methylprednisolone and cyclospori ne doses. However, the blood cyclosporine levels were significantly hi gher in the liver transplant recipients (P=0.001 1 year and P=0.005 2 years after Tx). Cortisol production was significantly lower in the li ver transplant recipients (P=0.002 1 year and P=0.049 2 years after Tx ), which suggests greater steroid-mediated suppression of adrenal func tion. Growth inhibition is more often observed in liver than in renal transplant recipients on similar triple immunosuppression, and may not be related to deficient function of the growth hormone-IGF-I axis. Si milar cyclosporine doses result in higher plasma levels of the drug an d similar methylprednisolone doses result in more inhibited adrenal co rtisol production in liver transplant recipients. In children with org an transplants, cyclosporine and methylprednisolone should be administ ered on an individual basis.