Skip to main content
SpringerLink
Log in

Growth after renal transplantation: Correlation with immunosuppressive therapy

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

The growth data for children transplanted between 1973 and 1987 were analysed according to their immunosuppressive regimen. All patients treated before 1985 received conventional treatment (prednisone, azathioprine); 37% of the prepubertal children with a follow-up of longer than 2 years showed catch-up growth, and 30% of the pubertal children exhibited a normal adolescent growth spurt. Reduced renal function and corticosteroid treatment are the two main causes of growth delay. The children transplanted between January 1985 and September 1987 were given either triple therapy [cyclosporine (CsA), prednisone, azathioprine] or conventional treatment after randomisation. Growth data were significantly better with CsA. The mean height gain for prepubertal children was +0.24 SD/year on triple therapy and +0.14 SD/year on conventional therapy during the 1st year after transplantation; and 0.4 SD/year and 0 SD/year during the 2nd year (P<0.05). The mean height gain for pubertal children was 5.6 cm/year on triple therapy and 3.6 cm/year on conventional therapy (P<0.005). The patients on triple therapy also received a significantly lower cumulative dose of prednisone. Some selected patients on triple therapy were taken off prednisone 12 months after transplantation. All patients showed catch-up growth (+0.83 SD/year in prepubertal children, 7.2 cm/year in pubertal children). In conclusion, protocols including CsA and the lowest cumulative dose of steroid (with alternate-day or even steroid withdrawal) allow the best restoration of growth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pennisi AJ, Costin G, Phillips LS, Uitten Bogaart CH, Ettenger RB, Malekzadeh MH, Fine RN (1977) Linear growth in long term renal allograft recipients. Clin Nephrol 8:415–421

    Google Scholar 

  2. Rizzoni G, Malekzadeh M, Pennisi A, Ettenger RB, Uitten Bogaart H, Fine RN (1980) Renal transplantation in children less than 5 years of age. Arch Dis Child 55:532–536

    Google Scholar 

  3. Bosque M, Munian A, Bewick M, Haycock G, Chantler C (1983) Growth after renal transplants. Arch Dis Child 58:110–114

    Google Scholar 

  4. Knight JF, Roy LP, Sheil AGR (1985) Catch up growth in children with successful renal transplants immunosuppressed with ciclosporine alone. Lancet I:159–160

    Google Scholar 

  5. Flechner SM, Conley SB, Van Buren CT, Rose G, Kerman R, Kahan BD (1985) Impact of ciclosporine on renal function and growth in pediatric renal transplant recipients. Transplant Proc 17:1284–1288

    Google Scholar 

  6. Ellis D, Avner ED, Rosenthal JT, Taylor R, Young L, Palumbi MA, Hakala T (1985) Renal function and somatic growth in pediatric cadaveric renal transplantation with ciclosporine-prednisone immunosuppression. Am J Dis Child 139:1161–1167

    Google Scholar 

  7. Broyer M, Gagnadoux MF, Guest G, Beurton D, Niaudet P Habib R, Busson M (1987) Kidney transplantation in children. Results of 383 grafts performed at Enfants-Malades Hospital from 1973 to 1984. Adv Nephrol 16:307–334

    Google Scholar 

  8. Broyer M, Gagnadoux MF, Guest G, Niaudet P (1987) Triple therapy including ciclosporine A versus conventional regimen. A randomised prospective study in pediatric kidney transplantation. Transplant Proc 19:3582–3585

    Google Scholar 

  9. Broyer M, Guest G (1989) Growth after kidney transplantation: a single center experience. In: Scharer K (ed) Growth and endocrine changes in children and adolescents with chronic renal failure. Karger, Basel, pp 36–45

    Google Scholar 

  10. Greulich WW, Pyle SI (1970) Radiographic atlas of skeletal development of the hand and wrist, 2nd edn. Standford University Press, New York

    Google Scholar 

  11. Sempe M, Pedron G, Roy-Pernot MP (1979) Auxologie, méthode et séquences. Théraplix, Paris, pp 35

    Google Scholar 

  12. Donckerwolcke RA, Chantler C, Broyer M, Brunner FP, Brynger H, Jacobs C, Kramer P, Selwood NH, Wing AJ (1980) Combined report on regular dialysis and transplantation of children in Europe 1979. Proc Eur Dial Transplant Assoc 17:87–115

    Google Scholar 

  13. Ingelfinger JR, Grupe WE, Harmon WE, Fernbach SK, Levey RH (1981) Growth accelaration following renal transplantation in children less than 7 years of age. Pediatrics 68:225–259

    Google Scholar 

  14. Rizzoni G, Broyer M, Brunner F, Brynger H, Challah S, Kramer P, Oules R, Selwood N, Wing A, Balas A (1984) Combined report on regular dialysis and transplantation of children in Europe. Proc Eur Dial Transplant Assoc 21:69–95

    Google Scholar 

  15. Vandiemen-Steenvoorde R, Donckerwolcke RA (1988) Growth and sexual maturation in paediatric patients treated by dialysis and following kidney transplantation. Acta Paediatr Scand Suppl 343: 109–116

    Google Scholar 

  16. Hoda Q, Hasinoff DJ, Arbus GS (1975) Growth following renal transplantation in children and adolescents. Clin Nephrol 3:6–9

    Google Scholar 

  17. Baxter JD (1978) Mechanisms of glucocorticoid inhibition of growth. Kidney Int 14:330–333

    Google Scholar 

  18. Travis LB, Chesney R, Mc Enery P, Moel D, Pennisi A, Potter D, Talkwalkar YB, Wolf E (1978) Growth and glucocorticosteroids in children with kidney disease. Kidney Int 14:365–368

    Google Scholar 

  19. McEnery PT, Gonzales LL, Martin LW, West CD (1973) Growth and development of children with renal transplant. Use of alternate day steroid therapy. J Pediatr 83:806–814

    Google Scholar 

  20. Fennell RS, Love JT, Carter RL, Hudson TM, Pfaff WW, Howard RJ, Van de Vsen W, Garin EH, Iravani A, Walker RD, Richard GA (1986) Statistical analysis of statural growth following kidney transplantation. Eur J Pediatr 145:377–379

    Google Scholar 

  21. Grushkin CM, Fine RN (1973) Growth in children following renal transplantation. Am J Dis Child 125:514–516

    Google Scholar 

  22. Broyer M, Rizzoni G, Brunner F, Brynger H, Challah S, Fassbinder W, Oules R, Selwood NH, Wing AT (1985) Combined report on regular dialysis and transplantation of children in Europe. Proc Eur Dial Transplant Assoc 22:55–79

    Google Scholar 

  23. Potter DE, Holliday MA, Wilson CI (1975) Alternate day steroids in children after renal transplantation Transplant Proc 7:79–82

    Google Scholar 

  24. Broyer M, Tete MJ, Levy M, Gagnadoux MF (1983) Alternate day prednisone after renal transplantation in children. Transplantation and clinical immunology. XV. Excepta Medica, Amsterdam. pp 169–178

    Google Scholar 

  25. Feldhoff C, Goldman AI, Najarian JS, Mauer SM (1984) A comparison of alternate day and daily steroid therapy in children following renal transplantation. Int J Pediatr Nephrol 5:11–14

    Google Scholar 

  26. Kaiser B, Polinsky M, Stover J, Jorge Baluarte H (1987) Growth after pediatric renal transplantation. Importance of alternate day steroids. Kidney Int 31:303

    Google Scholar 

  27. Offner G, Hoyer P, Juppner H, Krohn H, Brodehl J (1987) Somatic growth after kidney transplantation. Beneficial effect of ciclosporine in comparison with conventional immunosuppression. Am J Dis Child 141:541–546

    Google Scholar 

  28. Brodehl J, Ofnner G, Hoyer P (1987) Ciclosporine in pediatric kidney transplantation. Adv Nephrol 16:335–350

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatric Nephrology, Unité de Recherche INSERM U 192, Hôpital des Enfants-Malades, 149 rue de Sèvres, F-75743, Paris Cedex 15, France

    G. Guest & M. Broyer

Authors
  1. G. Guest
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Broyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guest, G., Broyer, M. Growth after renal transplantation: Correlation with immunosuppressive therapy. Pediatr Nephrol 5, 143–146 (1991). https://doi.org/10.1007/BF00852872

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00852872

Key words

Search

Navigation