What Have 20 Years of Data from the North American Pediatric Renal Transplant Cooperative Study Taught Us About Growth Following Renal Transplantation in Infants, Children, and Adolescents with End-Stage Renal Disease?

Publication Type
Journal Article
Year of Publication
2010
Authors
Fine, R; Martz, K; Stablein, D
Secondary
Pediatr Nephrol
Volume
25
Start Page
739
Pagination
739-746
Date Published
04/2010
Keywords
Adolescent; Child; Female; Growth; Growth Disorders; Infant; Kidney Failure-Chronic; kidney transplantation; Male; North America; Postoperative Complications; Postoperative Period; Preschool
ISBN
1432198X
Abstract
Growth following renal transplantation in infants, children, and adolescents was evaluated from 20 years of data reported to the registry of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). The analysis of more than 10,000 recipients addressed the following questions: 1. What is the impact of age, pubertal growth, gender, transplant history, donor source and allograft function on growth after transplantation? 2. Has the height Z score at the time of transplantation changed during the past two decades and has this influenced final adult height? 3. To what extent has recombinant human growth hormone (rhGH) been utilized in growth retarded recipients after transplantation and has its use resulted in accelerated post-transplantation growth? 4. Has the use of steroids for maintenance immunosuppression changed over the past 20 years and how have the perturbations of steroid usage influenced post-transplantation growth? 5. Have changes in clinical care resulted in improved final adult height Z score during the past two decades? Only younger children (<6 years) had initial accelerated post-transplantation growth. The mean increment in height during puberty was 18.8 cm (21.7 cm in 4.7 years for boys and 14.3 cm in 4.5 years for girls). Gender, source of donor graft, or number of grafts did not influence growth. Height Z score at transplantation has improved over the past two decades, as has final adult height with each succeeding era. The use of rhGH after transplantation results in a delta Z score of +0.5 standard deviation (SD). Post-transplantation growth improves with steroid avoidance and changes in estimated glomerular filtration rate (eGFR) impact on growth.