Acs. Hokkenkoelega et al., GROWTH AFTER RENAL-TRANSPLANTATION IN PREPUBERTAL CHILDREN - IMPACT OF VARIOUS TREATMENT MODALITIES, Pediatric research, 35(3), 1994, pp. 367-371
A retrospective study evaluated posttransplant growth of 70 prepuberta
l children during the first 2 y after renal transplantation (RTx). Imm
unosuppressive treatment consisted of prednisone administered either d
aily or on alternate days in combination with either azathioprine or c
yclosporin A. The increment in height standard deviation score for chr
onologic age during the first 2 y after RTx was less than 0.5 SD for 7
0% of the study population. The predictive factors for posttransplant
growth were determined by evaluating several factors and treatment mod
alities singly and simultaneously in a multiple regression analysis. P
atients with the most severe growth retardation at RTx appeared to hav
e the most pronounced growth spurt after RTx, but even they never had
complete catch-up growth, and 2 y after RTx they were still shorter th
an those with less severe growth retardation at RTx. Alternate-day ins
tead of daily prednisone administration had a significantly positive i
nfluence, whereas a high cumulative dose of prednisone, azathioprine i
nstead of cyclosporin A therapy, and a persistently reduced GFR (GFR <
50 mL/ min/1.73 m(2)) had a significantly negative influence on catch
-up growth during the 2 y after RTx. Other factors, such as gender, ch
ronologic and bone age at RTx, primary renal disease, duration of init
ial dialysis, repeat RTx, and target height SD score for chronologic a
ge, 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 c
atch-up growth during the first 2 y after RTx. Optimization of pretran
splant height appears very important. Immunosuppressive treatment with
cyclosporin therapy in combination with a minimal dose of alternate-d
ay prednisone would then result in optimal posttransplant growth, part
icularly if the GFR remains above 50 mL/min/1.7 m(2)).