Growth and pubertal development following pediatric heart transplantation.

Study aim: Prospective study of growth and pubertal development following p ediatric heart transplantation in 25 children. Patients and method: Twenty-five children underwent orthotopic cardiac tran splantation at Ste-Justine Hospital from July 1984 to August 1996. Systemat ic evaluation of anthropometric parameters (weight, height, bone age), horm onal profile (LH, FSH, testosterone, oestradiol, DHEAS), and pubertal devel opment according to Marshall and Tanner were done yearly. Results: Six patients had severe growth retardation at transplantation and only one patient was obese. All patients showed normal height increment fol lowing cardiac transplantation. Only 3 patients will not reach genetic targ et height. The 6 children suffering from congenital cardiomyopathy and show ing severe growth delay before surgery did not show any significant catch u p growth. Significant weight gain was observed during the first post-operat ive year (113+/-27% ideal body weight p=0.0002) with evolution towards norm al values at 2 years (100+/-18%). Thirteen patients were in the prepubertal stage at the time of transplant. Since then, one girl had her menarche at 11 years of age and 3 boys started their pubertal onset at 12 years old. Th e elevation of blood gonadotrophins during pubertal development correlated with progression of secondary sexual characteristics in both sexes. Conclusion: This pediatric population showed normal growth and normal onset and progression of puberty following cardiac transplantation. However, no catch-up growth was observed. The most important factor influencing attainm ent of maximal growth potential following heart transplantation was the deg ree of staturoponderal growth retardation at the time of surgery. (C) 2001 editions scientifiques et medicales Elsevier SAS.