ESPN 50th Annual Meeting

ESPN 2017


 
Predictors of post-transplant growth in prepubertal children with end-stage CKD
DORIS FRANKE 1 REINER REBLING 1 KERSTIN FROEDE 1 LEO PAVICIC 2 JUTTA GELLERMANN 3 DOMINIK M√úLLER 3 UWE QUERFELD 1 DIETER HAFFNER 1 MIROSLAV ZIVICNJAK 1

1- DEPARTMENT OF PEDIATRIC KIDNEY, LIVER AND METABOLIC DISEASES, HANNOVER MEDICAL SCHOOL, GERMANY
2- RENDICEVA 28B
3- DEPARTMENT OF PEDIATRIC NEPHROLOGY, CHARITé UNIVERSITY HOSPITAL, AUGUSTENBURGER PLATZ 1, 13353 BERLIN, GERMANY
 
Introduction:

 Disproportionate short stature is a frequent complication of CKD. Here we evaluated post-transplant growth during childhood in renal allograft recipients who were enrolled in the CKD Growth and Development observational cohort study.  

Material and methods:

 Linear growth (height, leg length, and sitting height) was prospectively investigated in a cohort 207 renal transplant recipients aged 2-12 years with a mean follow-up of 4.3 years.  Predictors of growth outcome after transplantation were evaluated by the use of linear mixed-effect models

Results:

 Pre-transplant mean SD scores (SDS) for all linear body dimensions were reduced (height, -2.32 SDS; sitting height, -1.49 SDS; leg length, -2.43 SDS), and sitting height index was increased (1.33 SDS) compared to healthy children (each p<0.001), indicating disproportionate short stature. After transplantation mean standardized height continuously increased until the age of 12 years (-1.38 SDS, p<0.01 vs. pre-transplant). Leg length was the anthropometric parameter with the greatest plasticity after transplantation. The preferential stimulation of leg growth resulted in normalization of sitting height index by puberty in most patients. Beside living-related transplantation, use of growth hormone in the pre-transplant period, steroid exposure, and hemoglobin levels were identified as potentially modifiable significant predictors of post-transplant growth. Growth hormone treatment before transplantation showed the highest impact on stature and sitting height, whereas transplantation at a young age (< 5 years) showed the strongest association with leg growth and consequently the degree of body disproportion.

Conclusions:

 Renal transplantation during childhood results in normalization of height in the vast majority of patients. Use of growth hormone in the pre-transplant period, living-related transplantation, transplantation at a young age, reduction of steroid exposure, and better control of anemia are promising measures further improving growth outcome.