Lipid profile during rhGH therapy in pediatric renal transplant patients

Abstract

To evaluate the effect of recombinant human growth hormone (rhGH) treatment on the lipid profile of pediatric renal transplant patients, we studied nine children treated with rhGH for 1 yr and a control group of 12 untreated patients matched in terms of age, renal transplant function and post-transplant follow-up. The levels of lipoprotein (a [Lp(a)], cholesterol, triglycerides, apolipoprotein A (APO A) and apolipoprotein B (APO B), and the APO B/APO A ratio, were determined at baseline and after 6 and 12 months of follow-up. RhGH therapy had no effect on cholesterol, triglycerides or apolipoproteins. Mean serum Lp(a) levels increased from 6.7 +/- 5.7 mg/dL at baseline to 11.8 +/- 10.7 after 6 months (p = 0.018) and 13.6 +/- 15.1 after 12 months of rhGH treatment (p = 0.04), but did not change in the control group. Lp(a) is a risk factor for cardiovascular morbidity, and increased Lp(a) levels may be a side-effect of rhGH treatment in renal transplant patients. Although long-term follow-up of a large number of patients is needed to establish the duration and extent of the effects of rhGH treatment on Lp(a) levels in transplanted children, serum Lp(a) levels should be carefully monitored in those receiving rhGH therapy.

Growth after renal transplantation

“…There has been no report of diabetes mellitus development under rhGH, but one patient with cystinosis has been reported. Recombinant human growth hormone has also been found to induce an increase in lipoprotein(a) serum concentration without a significant change in cholesterol or triglycerides serum concentrations [82]. This increase did not persist over time after a long-lasting treatment with rhGH in patients with Turner syndrome [83].…”

The role and future challenges for recombinant growth hormone therapy to promote growth in children after renal transplantation

“…Treatment with rGH has also been shown to improve linear growth in children after renal transplant. Randomized controlled trials performed to investigate the efficacy and safety of rGH use in growth-retarded transplant recipients demonstrated that rGH was consistently efficacious in improving the height velocity (HV) of renal transplant recipients (23)(24)(25)(26)(27)(28). Growth in the rGH-treated patients was increased by 7.7-9.0 cm/yr compared to 4.2-4.6 cm/yr in the control group in the two larger trials (25, 28) ( Table 2).…”

“…Slipped capital femoral epiphysis, avascular necrosis, glucose intolerance, and pancreatitis have not been shown to be associated with growth hormone therapy (35). There had been no difference in cholesterol, triglycerides, and apolipoproteins although lipoprotein (a) levels have been higher in rGH-treated patients (27). Many clinicians prefer to wait 6-12 months after successful renal transplantation to fully evaluate growth and initiate rGH therapy.…”

Changes in Endothelial Dysfunction and Associated Cardiovascular Disease Morbidity Markers in GH-IGF Axis Pathology

“…Intravenous infusion of acetylcholine and glyceryl trinitrate (nitroglycerin) significantly reduced PWV, by 6 -4% (p < 0.05) and 5 -2% (p < 0.01), respectively. [14] Growth hormone (GH) deficiency (GHD) predisposes individuals to an abnormal lipid profile and risk factors of the metabolic syndrome, including fibrinogen and plasminogen activator inhibitor, [15][16][17] which can adversely affect arterial endothelial function and increase APWV. [18,19] GHD is also liable to cause reduced skeletal muscle mass and strength, [20,21] contributing to reduced exercise capacity, [22] an altered substrate metabolism [23] and, therefore, reduced cardiac performance [22] with associated CVD.…”