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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ABSTRACT. A retrospective study evaluated posttransplant growth of 70 prepubertal children during the first 2 y after renal transplantation (RTx). Immunosuppressive treatment consisted of prednisone administered either daily or on alternate days in combination with either azathioprine or cyclosporin A. The increment in height standard deviation score for chronologic age during the first 2 y after RTx was less than 0.5 S D for 70% of the study population. The predictive factors for posttransplant growth were determined by evaluating several factors and treatment modalities singly and simultaneously in a multiple regression analysis. Patients with the most severe growth retardation at RTx appeared to have the most pronounced growth spurt after RTx, but even they never had complete catchup growth, and 2 y after RTx they were still shorter than those with less severe growth retardation a t RTx. Alternate-day instead of daily prednisone administration had a significantly positive influence, whereas a high cumulative dose of prednisone, azathioprine instead of cyclosporin A therapy, and a persistently reduced GFR (GFR < 50 mL/ min/1.73 m2) had a significantly negative influence on catch-up growth during the 2 y after RTx. Other factors, such a s gender, chronologic and bone age at RTx, primary renal disease, duration of initial dialysis, repeat RTx, and target height S D score for chronologic age, whether evaluated singly or simultaneously with other significant factors, appeared to have no significant influence on post-RTx growth. Thus, 70% of the prepubertal children do not experience appreciable catch-up growth during the first 2 y after RTx. Optimization of pretransplant height appears very important. Immunosuppressive treatment with cyclosporin therapy in combination with a minimal dose of alternate-day prednisone would then result in optimal posttransplant growth, particularly if the GFR remains above 50 mL/min/1.73 m2). (Pediatr Res 35: 367-371, 1994) Abbreviations RTx, renal transplantation hSDSca, height standard deviation score for chronologic age CsA, cyclosporin A Aza, azathioprine