Effects of growth hormone on growth factors after renal transplantation

Abstract

Growth retardation occurs frequently in renal transplanted children (RTx) and can be improved by growth hormone (GH) treatment. This study retrospectively examines the insulin-like growth factor-1 (IGF-1) and IGF binding protein (IGFBP) profile of ten growth-retarded children previously given renal allografts, after 1 year of GH treatment period. Ten prepubertal patients (nine boys and one girl) were investigated. They had a mean chronological age (CA) of 11.4 +/- 1.1 years and a mean bone age (BA) of 7.3 +/- 0.9 years. Mean height was -3.9 +/- 0.4 SD units below the mean for CA. The mean body mass index (BMI) was 16.9 +/- 0.6 and the mean inulin clearance was 36.5 +/- 4.9 ml/min/1.73 m2. Recombinant hGH was given at 4 IU/m2/day. Plasma GH, total and free IGF-1, IGFBP-2 and -3 were measured by specific radioimmunoassay (RIA). IGFBPs were characterized by SDS PAGE techniques and ligand and immunoblot analyses. Mean velocity was markedly increased (P < 0.01) after 1 year of GH therapy, expressed as SD score for BA. The range of growth response was wide. The total and free plasma IGF-1 increased (P < 0.01) by about 100% (mean values after GH therapy: 95.9 +/- 2.1 nM and 165 +/- 29 pM, respectively). Plasma IGFBP-3 concentrations increased by about 40% (mean value: 148 +/- 18 pM, P < 0.01), with a concomitant increase in both intact IGFBP-3 and its 30-kDa proteolytic fragment. There was no change in plasma IGFBP-2 concentration. Both mean values of inulin clearance and BMI were unchanged during the treatment. In view of the IGF-1/IGFBP concentration changes, there should have been an even better growth response to GH therapy in these patients. This strongly suggests IGF-1 insensitivity, probably as a result of corticosteroid therapy.

Adverse Effects of Immunosuppression in Pediatric Solid Organ Transplantation

“…[45] Recombinant human growth hormone (rhGH) has been used to accelerate growth following solid organ transplantation in patients who do not achieve an adequate growth response. Several studies have demonstrated the success of rhGH in increasing growth following kidney, [57] liver, [58] and heart transplantation. [59] The study criteria used for rhGH treatment in solid organ transplant recipients included prepubertal age, stable organ function for at least 1 year post-transplant, and a height z-score of less than -2.0 below the mean or growth velocity of <5 cm per year.…”

“…Growth velocity doubled within 1 year of rhGH treatment. [57][58][59] Cognitive and psychosocial development following solid organ transplantation has been less studied. This is largely due to the fact that these parameters are difficult to measure in infants and toddlers until language skills are well developed.…”

Growth in children after renal transplantation: An update

“…The use of rhGH both before and after transplant has improved growth and final height in renal transplant patients 63–73. Steroid use has been the main component of most post‐transplant immunosuppression regimens, as noted above.…”

Effects of Growth Hormone Therapy in Children After Cardiac Transplantation

“…Growth hormone (GH) has been used successfully to treat short stature in children after renal transplantation. 1 The use of GH to treat severe growth failure after cardiac transplantation in pediatric patients has not been reported previously. Although GH can increase growth velocity in these patients, even in the absence of GH deficiency, its effects on the cardiovascular system in these patients are not known.…”