Linear growth in pediatric kidney transplant recipients.
rhGH and preemptive transplantation are associated with improved growth in pediatric kidney transplant recipients, but ongoing monitoring is crucial for optimizing outcomes.
Where it sits
this study against the rest of the hgh (somatropin) corpusSummary and findings
This study evaluated linear growth in 62 pediatric kidney transplant recipients at Shaare Zedek medical center from 2013 to 2023. Mean height SDS improved from -2.08 to -1.6 over two years post-transplant. Use of rhGH and preemptive transplantation were associated with better growth outcomes.
Abstract
<h4>Background</h4>Growth impairment is a major concern in children with chronic kidney disease (CKD). Over the past two decades, recombinant human growth hormone (rhGH) has significantly improved linear growth in this population. Current recommendations support rhGH treatment in children with CKD who have a height below the 3rd percentile or reduced height velocity for age. Following kidney transplantation (KTx), rhGH, is usually deferred during the first post-transplant year until lack of spontaneous catch-up growth has been established. This study aimed to evaluate post-transplant growth in pediatric kidney transplant recipients and to examine its association with key demographic and clinical factors.<h4>Methods</h4>This study included all pediatric patients with kidney failure, who underwent KTx, at Shaare Zedek medical center, between January 2013 and December 2023. Demographic, clinical and laboratory data were retrieved from medical records.<h4>Results</h4>A total of 62 patients were included. Mean height standard deviation score (SDS) improved from - 2.08 two years pre-KTx to - 1.6 two years post-KTx. Most growth gain occurred in the first-year post-KTx. Use of rhGH was associated with significant improvement in linear growth. Preemptive transplantation and parental height were significantly associated with better growth outcomes. Need for rhGH before transplantation was associated with lower height SDS at all time points, although these patients demonstrated a similar degree of improvement over time.<h4>Conclusions</h4>Preemptive transplantation was associated with improved linear growth. Ongoing growth monitoring after KTx may enable early identification of suboptimal growth and timely reintroduction of rhGH treatment.
Background
Growth impairment is a significant concern in children with chronic kidney disease, and recombinant human growth hormone (rhGH) has been shown to improve linear growth in this population. Current guidelines recommend rhGH for children with CKD who have a height below the 3rd percentile or reduced height velocity. This study investigates post-transplant growth in pediatric kidney transplant recipients and its association with demographic and clinical factors.
Methods
The study was conducted at Shaare Zedek medical center and included pediatric patients with kidney failure who underwent kidney transplantation between January 2013 and December 2023. Data on demographics, clinical status, and laboratory results were collected from medical records. The primary outcome was the change in height standard deviation score (SDS) over time.
Results
The study included 62 patients, and the mean height SDS improved from -2.08 two years pre-transplant to -1.6 two years post-transplant. The majority of growth gain occurred in the first year post-transplant. Use of rhGH was associated with significant improvement in linear growth. Preemptive transplantation and parental height were significantly associated with better growth outcomes. Patients requiring rhGH before transplantation had lower height SDS at all time points but showed similar improvement over time.
Interpretation
The findings suggest that rhGH and preemptive transplantation can positively influence linear growth in pediatric kidney transplant recipients. While the improvement in height SDS is statistically significant, the clinical significance may vary depending on individual patient circumstances. The study is limited by its single-site design and small sample size, which may affect the generalizability of the results.
Key findings
- Mean height SDS improved from -2.08 to -1.6 over two years post-KTx.
- Most growth gain occurred in the first year post-KTx.
- Use of rhGH was associated with significant improvement in linear growth.
- Preemptive transplantation was significantly associated with better growth outcomes.
- Need for rhGH before transplantation was associated with lower height SDS at all time points.
Limitations
- Single-site study
- Small sample size of 62 patients
- Retrospective data collection from medical records
- Potential selection bias due to inclusion criteria