E. De Broux et al., Growth and pubertal development following pediatric heart transplantation:A 15-year experience at Ste-Justine hospital, J HEART LUN, 19(9), 2000, pp. 825-833
Background: Thirty-one children and adolescents have undergone allograft he
art transplantation at Ste-Justine Hospital from July 1984 to August 1996.
Twenty-five patients were followed prospectively more than 3 years to docum
ent their growth and pubertal development.
Methods: Parameters surveyed were clinical (height, weight, pubertal stagin
g, and bone age) and biochemical (luteinizing hormone (LH), follicle-stimul
ating hormone (FSH), testosterone, estradiol, dehydroepiandrosterone sulpha
te (DHEAS), IGF-1, and fasting insulin).
Results: At surgery, there were 18 boys and 7 girls aged 11 months to 17 ye
ars (median 13 years); 14 had congenital heart defects (CHDs) and 11 had a
cardiomyopathy (CM). Immunosuppressive therapy included cyclosporine, azath
ioprine, and prednisone. Eighteen patients were still growing (15 boys, 3 g
irls): 8 had a retarded bone age and 6 with CHD had severe growth failure.
Following surgery, most patients maintained their height within one sodium
dodecyl sulfate (SDS) score of that initially observed. Patients reaching t
heir target heights do so mainly in the lower range. Three patients not rea
ching target height had a CHD. Weight was greatest 1 year postoperatively (
113 +/- 27% ideal body weight) with normalization at 2 years (100 +/- 18%).
Of the 13 prepubertal patients, menarche occurred at age 12 in 1 girl, whi
le 3 boys began puberty at age 12 years. In both sexes, serum levels of gon
adotropins and IGF-1 increased during puberty, moderate hyperinsulinism was
observed, and DHEAS levels decreased.
Conclusions: Our results indicate that children and adolescents grow normal
ly following cardiac transplantation and that they attain their target heig
ht despite a lack of catch-up growth. They gain weight significantly in the
first postoperative year with normalization of their weight at 2 years. Fu
rthermore, the clinical and biochemical indices of puberty are overall with
in the norms. However, the severity of growth delay at the time of transpla
ntation inherent to the cardiac pathology has a major impact on adult heigh
t.