GROWTH-HORMONE IS NOT SAFE FOR CHILDREN WITH RENAL-TRANSPLANTS

Growth failure is an important problem in children with renal failure. Even after renal transplantation their growth rates may be lower than normal, and ''catch-up'' growth does not occur. Therefore there is gr eat interest in giving growth hormone (GH) after transplantation. Clin ical observations and theoretic considerations call into question whet her GH after transplantation is safe. Studies have shown a more rapid than normal decline in renal function after the initiation of GH thera py. This result could be explained by the effects of GH on the immune response. Growth hormone is known to modulate (usually upregulate) the immune response and could be a reason for the increased loss of renal function caused by rejection. It could also be explained by the long- term effects of GH on the injured kidney. Experimental data (generally not in the transplantation model) suggest that exogenous GH given aft er renal injury or reduced renal mass leads to a more rapid developmen t of glomerular sclerosis and reduced renal function. GH should not be administered to children after renal transplantation until all safety questions have been answered in prospective clinical trials.