FINAL HEIGHT AND ITS PREDICTIVE FACTORS AFTER RENAL-TRANSPLANTATION IN CHILDHOOD

A retrospective study is reported assessing final height (FH) and its predictive factors in 52 patients (31 male, 21 female) who underwent r enal transplantation (RTx) before the age of 15 y. They received predn isone daily or on alternate days as well as azathioprine. The study pe riod covered 20 y. FH remained below the third height percentile [heig ht standard deviation score for chronologic age (hSDS(CA)) < -1.88] fo r most of these patients (77% males, 71% females). Median (range) FH w as 165.0 (143.0-176.8) cm in males and 153.0 (135.0-168.4) cm in femal es. Median difference between FH and target height was 15.0 and 15.4 c m for males and females, respectively. For both sexes, the median hSDS ,, was already below -1.88 at the start of the first hemodialysis, aft er which it decreased significantly until the first RTx. After RTx, th ere was no significant improvement of hSDS(CA). The predictive factors for FH were determined by evaluating various factors simultaneously i n a multiple regression analysis. This analysis provided a regression equation for predicting FH. A higher hSDS(CA) at the time of the first RTx and alternate-day versus daily prednisone therapy both had a sign ificantly positive influence on FH, whereas a longer duration of reduc ed GFR (<50 mL/min/1.73 m(2)) had a significantly negative effect on F H. Other factors such as age or bone age at first RTx, primary renal d isease, duration of initial dialysis, repeat RTx, and the cumulative d ose of prednisone did not influence FH significantly. In conclusion, 7 1-77% of patients that received their first renal transplant before th e age of 15 ended up with severely short adult stature. Optimization o f the hSDS(CA) at first RTx appears very important. Long-term administ ration of prednisone on alternate days would then result in optimal FH , particularly if the GFR remains above 50 mL/min/1.73 m(2).