Effects of growth hormone in short children after renal transplantation

Abstract

From 1991 to 1993, 90 children having received a kidney graft with a post-transplantation period of at least 12 months were included in a prospective study carried out in 18 French pediatric centers. After informed consent and randomization, children received recombinant human growth hormone (rhGH) (Genotonorm, Pharmacia peptide hormones) 30 U/m2 per week, either immediately on enrollment, for the treated group, or after 1 year of follow-up for the group serving as a control. After 1 year both groups were treated and we analyzed data during the subsequent years. Eighty-five children completed the 1-year study. Growth velocity was significantly increased by rhGH: 7.7 cm with a gain of +0.3 standard deviation score in the treated group versus 4.6 cm in the control group (P<0.0001) during the 1st year. Four factors predicted response to therapy: growth velocity prior to GH therapy, glomerular filtration rate (GFR) at the start, mode of corticosteroid administration, and degree of insulin resistance. After 1 year we observed a moderate, significant decrease in GFR in both groups. Biopsy-proven acute rejection episodes were not significantly more frequent during the 1st year in the group of patients who received rhGH: 9 in 44 versus 4 in 46 patients. The patients who rejected did not differ in terms of age, renal function at the start, and type of immunosuppression, but history of rejection before GH treatment was discriminatory: 6 of 17 children with two or more episodes had a new rejection versus 1 of 22 who had no or only one episode (P=0.01). Glucose tolerance was not modified after 1 year of GH therapy. During the subsequent years of treatment a decrease in growth velocity was noted: 5.9 cm at 2 years, 5.5 at 3 years, and 5.2 cm at 4 years. In conclusion, GH is efficient for improving growth velocity in short transplanted children, inducing clear-cut but limited catch-up growth. The risk of rejection was shown only in patients with a prior history of more than one rejection episode.

Growth hormone treatment after renal transplantation: a promising but underused chance to improve growth

“…The first large randomized clinical study from France involving 90 short children after TPL did not show a significant difference between study and control patients [21]. The number of patients with rejection episodes in both groups was not significantly different.…”

Tratamento com hrGH da baixa estatura induzida pelo uso crônico de glicocorticóide em crianças

“…A aceleração da VC foi descrita em outros estudos envolvendo uso de hrGH em pacientes com DII e em pacientes sob corticoterapia pós-transplante renal (22,27).…”

“…É importante destacar que o controle da doença de base, do quadro inflamatório e o estado nutricional representam fatores importantes na determinação do crescimento destas crianças e conseqüentemente da melhor ou pior resposta ao GH (23,39,40). Um caso isolado de papiledema, sem outros sinais de hipertensão intracraniana benigna, revertido com a suspensão do hrGH, e um caso de epifisiólise da cabeça do fêmur foram descritos, ambos em pacientes pós-transplante renal, existindo questionamento sobre a participação da terapia com hrGH em alguns casos de rejeição do enxerto renal (22,27).…”

rhGH Treatment in Corticosteroid-Treated Patients

“…In children with kidney transplants, controlled studies [53] revealed no difference between the GH-treated group and the control group in the incidence of acute rejection. However, a French study [54] reported that more than one acute rejection episode prior to rhGH treatment was a risk factor for subsequent episodes during rhGH treatment. rhGH treatment in GC patients appears to be safe and does not significantly modify the course of disease.…”