Catch-up growth of children with graft survival after kidney transplantation: A cohort study

Abstract

Objective: To describe and explore the clinical characteristics and associated factors of growth in children after kidney transplantation (KT). Method: Retrospective study was performed on the clinical data of 111 children who underwent allogeneic KT and met the inclusion criteria (provided by Guangzhou Women and Children’s Medical Center and the Sun Yat-sen University First Affiliated Hospital). Catch-up growth was defined as present if the increment of height standard deviation score (∆Ht-SDS) was ≥0.5 per year. Described the clinical characteristics and compared possible associated factors between children with catch-up growth and no catch-up growth groups. Result: The median age at KT was 9(6,12) years, and 54.1% (60/111) are females. Mean height-SDS before KT was -2.14±1.29, 55.9% (62/111) showed growth retardation. Catch-up growth within the first years post-KT was present in 47.7% (53/111) recipients, the mean ∆Ht-SDS was 0.53±0.71. The Ht-SDS before KT was positively associated with last follow-up Ht-SDS (R=0.78, P<0.001). The baseline Ht-SDS, transplantation age, serum creatinine, and GC dose were significantly lower in the chase group (all P≤0.05), multivariate logistic regression analysis indicated that lower baseline Ht-SDS and serum creatinine were the protect factors for catch-up growth on the 1st year of post-transplantation (OR=0.62, 0.97, respectively, P<0.05). The last follow-up Ht-SDS affected by baseline Ht-SDS and ∆Ht-SDS. HtSDS was no statistical difference among different age groups (patient age at KT: <6years,6-9 years,9-12years,>12years), but ∆Ht-SDS showed significant difference between groups (0.74±0.80, 0.82±0.73, 0.28±0.67, 0.32±0.47, respectively, P<0.05). Younger Children showed significant catch-up rate after KT(<9years:68%,>9years:31%), however the ∆Ht-SDS was decrease in the second year (P<0.05). Conclusion: Growth assessment and management should be performed in any pediatric KT recipients. Even in younger children with more catch-up potential, ∆Ht-SDS decreased significantly at second year, growth continues to be suboptimal after KT. Given that baseline ∆Ht-SDS is a significantly associated factor, it is important for children with severe growth retardation need early identification and plan interventions in terms of growth improvement. We expected the children recipients achieved the ideal target height of post-transplantation.