Predictors of final adult height after renal transplantation during childhood: A single-center study

Aim: Assessment of final adult height and its predictive factors in childre n transplanted (RTx) and followed up in a single center. Methods: A cohort of 32 patients (17 boys, 15 girls) who received RTx before the age of 15 ye ars and had reached a final adult height was selected. Twenty patients rece ived a single RTx, 9 patients received two RTx, and 3 patients received thr ee RTx. Seven children were transplanted preemptively, white the remaining 25 children received peritoneal dialysis for relatively short periods of ti me. In 11 patients, recombinant human growth hormone (rhGH) was administere d either before (n = 8) or after (n = 3) RTx. Results: In 13 patiens (41%), the final height standard deviation score for chronological age (hSDS) was -2.3 +/- 0.5, below the 95% confidence limits for target height (group A), while in 19 patients (59%), it was -0.7 +/- 0.8, within the 95% confidence limits for target height (group B). The hSDS values at the start of dialys is and at the time of first RTx were significantly lower in group A than in group B. A higher hSDS at the start of dialysis and at the time of first R Tx had a significant positive influence on the final height (FH), whereas a longer duration of dialysis had a significant negative effect on the FH. A dministration of rhGH after RTx played an important role in the achievement of a normal FH in 3 girls. No differences were observed between group A an d B with respect to age at start of dialysis, chronological or bone age at first RTx, number of rejection episodes, duration of the study period from last RTx to FH, glomerular filtration rate during this study period, or per centage of time on prednisone therapy. Conclusions: The FH is almost exclus ively predetermined by the height achieved at the start of dialysis and at the time of first RTx. Therefore, to reach target adult height after RTx, t he best strategy is to shorten the time of dialysis and to start rhGH admin istration at a young age and as early as possible during the course of chro nic renal failure. Administration of rhGH after RTx is also highly effectiv e, but, given its potential danger, still remains a matter of investigation . Copyright (C) 2000 S. Karger AG, Basel.