S. Sarna et al., DIFFERENCES IN LINEAR GROWTH AND CORTISOL PRODUCTION BETWEEN LIVER AND RENAL-TRANSPLANT RECIPIENTS ON SIMILAR IMMUNOSUPPRESSION, Transplantation, 60(7), 1995, pp. 656-661
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.