Predictors of Final Adult Height after Renal Transplantation during Childhood: A Single-Center Study

Abstract

Aim: Assessment of final adult height and its predictive factors in children transplanted (RTx) and followed up in a single center. Methods: A cohort of 32 patients (17 boys, 15 girls) who received RTx before the age of 15 years and had reached a final adult height was selected. Twenty patients received a single RTx, 9 patients received two RTx, and 3 patients received three RTx. Seven children were transplanted preemptively, while the remaining 25 children received peritoneal dialysis for relatively short periods of time. In 11 patients, recombinant human growth hormone (rhGH) was administered either before (n = 8) or after (n = 3) RTx. Results: In 13 patiens (41%), the final height standard deviation score for chronological age (hSDS) was –2.3±0.5, below the 95% confidence limits for target height (group A), while in 19 patients (59%), it was –0.7±0.8, within the 95% confidence limits for target height (group B). The hSDS values at the start of dialysis and at the time of first RTx were significantly lower in group A than in group B. A higher hSDS at the start of dialysis and at the time of first RTx had a significant positive influence on the final height (FH), whereas a longer duration of dialysis had a significant negative effect on the FH. Administration of rhGH after RTx played an important role in the achievement of a normal FH in 3 girls. No differences were observed between group A and B with respect to age at start of dialysis, chronological or bone age at first RTx, number of rejection episodes, duration of the study period from last RTx to FH, glomerular filtration rate during this study period, or percentage of time on prednisone therapy. Conclusions: The FH is almost exclusively predetermined by the height achieved at the start of dialysis and at the time of first RTx. Therefore, to reach target adult height after RTx, the best strategy is to shorten the time of dialysis and to start rhGH administration at a young age and as early as possible during the course of chronic renal failure. Administration of rhGH after RTx is also highly effective, but, given its potential danger, still remains a matter of investigation.

Growth after renal transplantation in infancy or early childhood

“…Although improvements have been made in several aspects of treatment, target adult height has not been achieved in the majority of patients. The final height was below the 95% confidence limits for target height in 41% of children transplanted before the age of 15 years in a report by Rodriguez-Soriano, even though some of the patients had been treated with GH [14].…”

Adult Height in Patients with Advanced CKD Requiring Renal Replacement Therapy during Childhood

“…In recent years, several single-center reports have specifically addressed final height after transplantation in childhood (9)(10)(11)(12)(13). The proportion of patients who achieved a final height within the normal range ranged from 47% to 75%, which appears considerably improved over early reports in which normal adult height was achieved in only 23%-38% (14,15).…”

Adult height of three renal transplant patients after growth hormone therapy

“…8 However there are very few reports on adult height after rhGH therapy. The three patients reported by Offner et al 9 and the 3 patients reported by Rodriguez-Soriano et al 10 showed benefi cial effects of rhGH therapy. The mean adult height SDS values in these two studies 9,10 were −1.9 and −0.6.…”

“…Their height SDS was −2.7 at start of rhGH therapy and −1.8 at adult height. The reports by Offner et al, 9 Rodriguez-Soriano et al, 10 and Fine et al 13 had no information about steroid therapy. Administration of rhGH may affect the immune system and induce hyperfi ltration and may have deleterious effects on graft function.…”

“…The results of long-term studies indicate that rhGH is effective and safe for use in growth-retarded pediatric renal transplant recipients. [8][9][10][11][12][13] The sole effect of rhGH on adult height in our patients is hard to assess because of the compounding effects of the pubertal growth spurt and steroid withdrawal. Our three patients with very short stature at transplantation showed catch-up growth, and the adult heights of two of the patients (patients 2 and 3) were over their target heights.…”