Statistical analysis of statural growth following kidney transplantation

Several factors influencing post-transplant growth were analysed in a total of 163 children receiving transplants at the Medical School Hannover. Statural height at the time of transplantation depended on the length of the pre-transplant period of chronic renal failure, and was more retarded in children with congenital renal diseases than in those with acquired diseases. The retardation of bone age correlated significantly with the degree of growth retardation. The immunosuppressive regimen of cyclosporine A (CyA) and low-dose prednisolone was followed by significantly better growth rates than azathioprine (Aza) plus high-dose prednisolone. In 22 prepubertal children receiving CyA, poor graft function with a glomerular filtration rate below 40 ml/min per 1.73 m2 inhibited catch-up growth. The final height of 20 grown-up transplant recipients was found to be in the lower range of normal. A comparison of conventional and CyA treatment showed that adult height in the CyA group was higher than in the Aza group due to a significantly higher growth velocity.

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“…This is in agreement with other reports [29,35]. Pubertal growth is also influenced by the immunosuppressive regimen.…”

Section: Discussionsupporting

confidence: 94%

Growth after renal transplantation: an update

1991

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“…Others have observed that reduction in renal graft function was associated with a marked deceleration in growth velocity after RTx (14,15), but until now no information on its association with FH has been provided. In a previous study in 19 growthretarded renal allograft patients with a mean GFR of 66 mLlminl1.73 m' , we found a negative correlation between renal graft function and the serum IGF-binding protein-3 levels.…”

Section: Discussionmentioning

confidence: 99%

Final Height and Its Predictive Factors after Renal Transplantation in Childhood

et al. 1994

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Erasmus University Rotterdam, The NetherIand.7 1M.A. J.d. R., T. S. 1A retrospective study is reported assessing final height (FH) and its predictive factors in 52 patients (31 male, 21 female) who underwent renal transplantation (RTx) before the age of 15 y. They received prednisone daily or on alternate days as well as azathioprine. The study period covered 20 y. FH remained below the third height percentile [height standard deviation score for chronologic age (hSDS,,) < -1.881 for most of these patients (77% males, 71% females). Median (range) FH was 165.0 (143.0-176.8) cm in males and 153.0 (135.0-168.4) cm in females. Median difference between FH and target height was 15.0 and 15.4 cm for males and females, respectively. For both sexes, the median hSDS,, was already below -1.88 at the start of the first hemodialysis, after which it decreased significantly until the first RTx. After RTx, there was no significant improvement of hSDS,,.The predictive factors for FH were determined by evaluating various factors simultaneously in a multiple regression analysis. This analysis provided a regression equation for predicting FH. A higher hSDS,, at the time of the first RTx and alternate-day versus daily prednisone therapy both had a significantly positive influence on FH, whereas a longer duration of reduced GFR ( 4 0 mLlminl1.73 m') had a significantly negative effect on FH. Other factors such as age or bone age at first RTx, primary renal disease, duration of initial dialysis, repeat RTx, and the cumulative dose of prednisone did not influence FH significantly. In conclusion, 71-77% of patients that received their first renal transplant before the age of 15 ended up with severely short adult stature. Optimization of the hSDS,., at first RTx appears very important. Long-term administration of prcdnisone on alternate days would then result in optimal FH, particularly if the GFR remains above 50 mL/min/1.73 m2. (Pediatr Res 36: 323-328, 1994) Abbreviations FH, final heightRTx, renal transplantation hSDS,,, height standard deviation score for chronologic age HD, hemodialysis AD, alternate-day Growth failure is a common and serious consequence of chronic renal failure in childhood. The majority of these children now survive thanks t o advances in hemodialysis and RTx, but successful transplantation rarely results in full growth rehabilitation. Some children show an appreciable improvement in growth after RTx, but the initially increased growth rate may not be sustained during the ensuing years of immunosuppressive drug administration (1). reported that the F H of o n e third of patients w h o underwent RTx

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Renal Transplantation in the Infant and Young Child

Kalia¹

1988

Arch Pediatr Adolesc Med

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Statistical analysis of statural growth following kidney transplantation

Cited by 11 publications

References 21 publications

Growth after renal transplantation: an update

Growth after renal transplantation: an update

Final Height and Its Predictive Factors after Renal Transplantation in Childhood

Renal Transplantation in the Infant and Young Child

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