Factors influencing growth and final height after renal transplantation (original) (raw)
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Evaluation of growth in children and adolescents after renal transplantation
The Turkish Journal of Pediatrics
Despite the advances in the last decades, it is well-known that optimal growth is usually not achieved in children with chronic kidney disease (CKD) even after successful renal transplantation (RTx). In this study, our aim was to evaluate growth patterns and factors affecting growth in pediatric and adolescent renal transplant recipients (RTR). Thirty-seven prevalent RTR with mean age of 17.0±2.9 years and mean post-RTx duration of 4.2±2.0 years were evaluated. Growth parameters, height velocities and factors affecting growth at the time of RTx (baseline) and in the post-RTx follow-up were also retrospectively assessed. Cumulative corticosteroid (CS) doses were calculated. Mean height and weight standard deviation score (SDS) values were negative (-1.4±1.1 and-1.2±1.5, respectively), whereas height SDS was positive in 16% of the patients. Mean weight, height, and BMI (body mass index) SDS of the RTR were significantly higher than the values at transplantation (p<0.001 for weight and height SDS; p<0.05 for BMI SDS). Height SDS was <-2.0 in 19% of the patients while 60% at the baseline. Main factors associated with post-RTx height SDS were pre-RTx height SDS (B: 0.448, p<0.01) and CKD duration (B:-0.01, p<0.05). Although it was much better than the pre-RTx period, the present study reveals that post-RTx growth was less than anticipated. As well as minimizing post-RTx CS doses and preserving graft function in the post-RTx follow-up, performing early transplantation and all efforts for minimizing pre-RTx growth deficit are crucial for an optimal post-RTx growth.
Interfering Factors in the Growth of the Pediatric Population after Kidney Transplantation
2022
Growth failure is a marked feature in children with CKD. Kidney transplantation (KTx) is the therapeutic option that provides the greatest benefits to the pediatric population. Considering the importance of this subject, a systematic search of the literature was carried out on the principal databases from January 2015 to December 2020. The following descriptors in health science (DECs) from the VHL portal (library virtual health) were applied: pediatric kidney transplantation (PKTx), growth and development. It was found that among the etiologies, congenital abnormalities of the kidneys and urinary tract (CAKUT) were the main causes of loss of renal function. The highest mean age was 15.52 ± 1.8 years. The type of donor was reported in only 3 studies, in 1 of which the living donor was predominant. The immunosuppression (ISS) schemes after PKTx were similar in the studies, the triple scheme with corticoid, calcineurin inhibitor and anti-proliferative being used in most of them. The use of GH did not occur in 4 of the 9 studies. We could conclude that weight and height gain after PKTx is an important outcome to be evaluated. In underdeveloped or developing countries where, in addition to chronic disease, we find nutritional and economic precariousness, it is very important to know the factors that greatly contribute to the impairment of height and weight gain of these patients. Controlled and randomized studies that find answers for the control of pediatric patients after PKTx and that can be applied in our country are desired.
Determinants of growth after kidney transplantation in prepubertal children
Pediatric Nephrology
Background Short stature is a frequent complication after pediatric kidney transplantation (KT). Whether the type of transplantation and prior treatment with recombinant human growth hormone (GH) affects post-transplant growth, is unclear. Methods Body height, leg length, sitting height, and sitting height index (as a measure of body proportions) were prospectively investigated in 148 prepubertal patients enrolled in the CKD Growth and Development study with a median follow-up of 5.0 years. We used linear mixed-effects models to identify predictors for body dimensions. Results Pre-transplant Z scores for height (− 2.18), sitting height (− 1.37), and leg length (− 2.30) were reduced, and sitting height index (1.59) was increased compared to healthy children, indicating disproportionate short stature. Catch-up growth in children aged less than 4 years was mainly due to stimulated trunk length, and in older children to improved leg length, resulting in normalization of body height and ...
Growth after renal transplantation: Correlation with immunosuppressive therapy
Pediatric Nephrology, 1991
The growth data for children transplanted between 1973 and 1987 were analysed according to their immunosuppressive regimen. All patients treated before 1985 received conventional treatment (prednisone, azathioprine); 37% of the prepubertal children with a follow-up of longer than 2 years showed catch-up growth, and 30% of the pubertal children exhibited a normal adolescent growth spurt. Reduced renal function and corticosteroid treatment are the two main causes of growth delay. The children transplanted between January 1985 and September 1987 were given either triple therapy [cyclosporine (CsA), prednisone, azathioprine] or conventional treatment after randomisation. Growth data were significantly better with CsA. The mean height gain for prepubertal children was +0.24 SD/year on triple therapy and +0.14 SD/year on conventional therapy during the 1st year after transplantation; and 0.4 SD/year and 0 SD/year during the 2nd year (P <0.05). The mean height gain for pubertal children was 5.6 cm/year on triple therapy and 3.6 cm/year on conventional therapy (P <0.005). The patients on triple therapy also received a significantly lower cumulative dose of prednisone. Some selected patients on triple therapy were taken off prednisone 12 months after transplantation. All patients showed catch-up growth (+0.83 SD/year in prepubertal children, 7.2 cm/year in pubertal children). In conclusion, protocols including CsA and the lowest cumulative dose of steroid (with alternate-day or even steroid withdrawal) allow the best restoration of growth.
Evaluation of growth and body mass index in children following kidney transplantation.
Growth retardation is common among children with chronic kidney disease (CKD). Renal transplantation has beneficial effects on height and weight gain of children, but height gain occurs especially for those children who are transplanted at a younger age. This study was conducted for a cross-sectional evaluation of growth and body mass index (BMI) in children following kidney transplantation. All children who had been transplanted in our center and had regular follow-up were entered in this study. Those with primary non-functioning grafts were excluded from the study. Weight and height at transplantation and at 20 years of age or at a pre-determined period (1-4-2008 to 30-6-2008) were recorded. Their height, weight, BMI, standard deviation score (SDS) of height and weight at their pre- and post-transplantation period were compared. SPSS 15.1 software and paired t-test were used for comparison of means. Seventy-one children, 43 boys and 28 girls, were involved in this study. The mean age at transplantation was 12.6 ± 3.45 years, ranging from 3 to 19 years, and age at last visit was 16.9 ± 3.15 years. They had been followed-up for 7-175 months (mean, 51.6 ± 30.75 months). Their primary renal diseases were as follows: reflux, obstruction and dysplasia 29 (41%), hereditary 25 (35%), glomerular disease 14 (20%), unknown 3 (4%). Source of donor was living related in 27 (38%), with 15 being mothers, deceased in 35 (49%) and living unrelated in 9 (13%). SDS height improved dramatically in post-transplantation evaluation, but this did not happen for SDS weight and BMI. We can conclude that despite a dramatic effect of transplantation on growth, catch-up growth only occurred in a minority of the children.
Transplantation, 2020
Financial disclosure: The ESPN/ERA-EDTA Registry is funded by the European Society for Paediatric Nephrology (ESPN) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). This article was written by M Bonthuis et al. on behalf of the ESPN/ERA-EDTA Registry and the ERA-EDTA Registry which is an official body of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association). Conflicts of interest: The authors declare no conflicts of interest.
Pediatric Nephrology, 1998
, 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/m 2 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 effi-cient 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. & k w d :