EFFICACY AND SAFETY OF GROWTH-HORMONE TREATMENT IN SHORT CHILDREN WITH RENAL-ALLOGRAFTS - 3 YEAR EXPERIENCE

The majority of children with renal allografts have diminished growth and reduced final height. Impaired allograft function and glucocortico id treatment are the main contributing factors. Since recombinant huma n growth hormone (rhGH) treatment was able to counteract the growth de pressing effects of glucocorticoids in experimental uremia, an open-la beled prospective study in 17 short children with renal allografts was designed to investigate the efficacy of rhGH therapy (30 IU/m2/week) with special emphasis on the safety regarding graft function and carbo hydrate metabolism. Height velocity in prepubertal children (N = 10) i ncreased from baseline median 2.2 cm/year to 7.9 cm/year after one yea r (P < 0.01), 7.2 cm/year after two years (P < 0.01), and 5.5 cm/year (P < 0.05) after three years of rhGH therapy. This resulted in a norma lization of height in three out of seven patients after two years and in three out of five after three years of therapy. Growth stimulation in pubertal children was less consistent. Bone maturation paralleled c hronological age. The effect of rhGH treatment on longitudinal growth may be partially attributable to the improved ratio between the serum concentration of the insulin-like growth factor (IGF)-I and its major binding protein (BP) IGFBP-3 leading to a normal IGF bioactivity. The incidence of acute rejection crises in the study group (corrected for time after grafting) did not differ from that of untreated retrospecti ve ''controls'' (0. 10 vs. 0. 12 episodes per patient and year). No sy stematic effect of rhGH on glomerular filtration rate assessed by repe ated inulin and creatinine clearances was noted. The major metabolic e ffect of rhGH was a continuous increase in fasting and stimulated insu lin serum levels up to three years, whereas glucose tolerance did not change with time. It is concluded that rhGH markedly improves growth o f prepubertal children with renal allografts without obvious serious s ide effects within the observation period of three years. Therapy with rhGH may become a new treatment modality in short slowly growing chil dren after renal transplantation.