Growth following solid organ transplantation in childhood

Fine, Richard Ν.

doi:10.6061/clinics/2014(sup01)02

Cited by 7 publications

(11 citation statements)

References 25 publications

(22 reference statements)

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“…In addition, they directly induce growth plate inhibition 3 . Switching from daily to alternate day use, CS withdrawal or avoidance all lead to improved growth velocity in RTR 5 . In the present study, we demonstrated a significant negative correlation between mean height SDS and the cumulative CS doses at all post-RTx periods.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4] Post-RTx growth is affected by three major factors: age at RTx, allograft function and corticosteroid (CS) dose. 5 The degree of pre-RTx growth deficit, use of a deceased donor, presence of post-RTx persistent hyperparathyroidism and malnutrition are other negative predicting factors. 3 Pubertal growth spurt is also delayed by 1.5 years and it lasts 1.6 years shorter in children with RTx; contributing to the persistence of growth retardation.…”

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confidence: 99%

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Evaluation of growth in children and adolescents after renal transplantation

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Evaluation of growth in children and adolescents after renal transplantation

et al. 2019

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“…In liver transplanted young adults, height might be a better parameter than age (which is used by the MDRD formula), as these patients may have suboptimal growth development for their age both before and after LT 4 due to pre‐LT malnutrition, growth restriction, diagnosis, and/or prolonged steroid use after LT 32 …”

Section: Discussionmentioning

confidence: 99%

Comparison of cystatin C, creatinine, and iohexol clearance in pediatric liver transplantation—a retrospective cohort study

Bluhme

Malenicka

Fischler

et al. 2021

Pediatric Transplantation

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Impaired renal function after pediatric (LT) is a recognized problem. Accurate monitoring of (GFR) is imperative to detect declining renal function. GFR can be estimated via s‐creatinine and/or p‐cystatin C or measured by inulin and or/iohexol clearances. We retrospectively compared eGFRcrea and eGFRcyst, to mGFRiohex after LT. Data from 91 children with 312 concomitant measurements of s‐creatinine, p‐cystatin C, and iohexol clearance, obtained between 2007 and 2015, were analyzed. eGFR was calculated by using the p‐cystatin C‐based CAPA and CKD‐EPI formulas, and the s‐creatinine‐based Schwartz‐LYON, FAS, revised Schwartz and MDRD formulas. Also, the arithmetic means of cystatin C‐based and creatinine‐based equations were used. Every calculated eGFR was compared to mGFRiohex in statistical correlation, accuracy, precision, bias, and misclassifications. Among the different equations, p‐cystatin C‐based formulas (CAPA and CKD‐EPI) as well as the s‐creatinine‐based Schwartz‐LYON formula showed the most correct estimates regarding accuracy (84–87.5%), bias (0.19–4.0 ml/min/1.73 m2), and misclassification rate (24.7–25%). In patients with renal function <75 ml/min/1.73 m2, cystatin C‐based formulas were significantly more accurate and less biased than creatinine‐based formulas. In conclusion, S‐creatinine could be used in a clinical setting on a regular basis in liver transplanted pediatric patients, with reliable results, if eGFR is calculated by the Schwartz‐LYON formula. When suspected renal dysfunction, cystatin C‐based eGFR should be calculated, since it gives more accurate and less biased estimates than creatinine‐based eGFR, and should be confirmed by mGFR (iohexol).

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“…One of the main goals of pediatric SOT is for recipients to attain a normal adult height. [73][74][75] Among liver transplant recipients, 73% were found to be below average height 5 years post transplant, 11 and up to 58% of kidney transplant recipients do not attain a normal final height. 73 Younger age at transplant, improved graft function, and shorter duration of steroids have been associated with better catch-up growth.…”

Section: Growth and Nutritionmentioning

confidence: 99%

Care of Pediatric Solid Organ Transplant Recipients: An Overview for Primary Care Providers

et al. 2020

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As the number of living pediatric solid organ transplant (SOT) recipients continues to grow, there is an increased likelihood that primary care providers (PCPs) will encounter pediatric SOT recipients in their practices. In addition, as end-stage organ failure is replaced with chronic medical conditions in transplant recipients, there is a need for a comprehensive approach to their management. PCPs can significantly enhance the care of immunosuppressed hosts by advising parents of safety considerations and avoiding adverse drug interactions. Together with subspecialty providers, PCPs are responsible for ensuring that appropriate vaccinations are given and can play an important role in the diagnosis of infections. Through early recognition of rejection and posttransplant complications, PCPs can minimize morbidity. Growth and development can be optimized through frequent assessments and timely referrals. Adherence to immunosuppressive regimens can be greatly improved through reinforcement at every encounter, particularly among adolescents. PCPs can also improve long-term outcomes by easing the transition of pediatric SOT recipients to adult providers. Although guidelines exist for the primary care management of adult SOT recipients, comprehensive guidance is lacking for pediatric providers. In this evidence-based overview, we outline the main issues affecting pediatric SOT recipients and provide guidance for PCPs regarding their management from the first encounter after the transplant to the main challenges that arise in childhood and adolescence. Overall, PCPs can and should use their expertise and serve as an additional layer of support in conjunction with the transplant center for families that are caring for a pediatric SOT recipient.

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Growth following solid organ transplantation in childhood

Cited by 7 publications

References 25 publications

Evaluation of growth in children and adolescents after renal transplantation

Evaluation of growth in children and adolescents after renal transplantation

Comparison of cystatin C, creatinine, and iohexol clearance in pediatric liver transplantation—a retrospective cohort study

Care of Pediatric Solid Organ Transplant Recipients: An Overview for Primary Care Providers

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