GROWTH AFTER RENAL-TRANSPLANTATION IN PREPUBERTAL CHILDREN - IMPACT OF VARIOUS TREATMENT MODALITIES

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)).