Fine Richard N
Department of Pediatrics, SUNY at Stony Brook, Stony Brook, New York 11794-8111, USA.
Pediatr Transplant. 2002 Feb;6(1):47-52. doi: 10.1034/j.1399-3046.2002.1p067.x.
One of the ultimate goals of successful transplantation (Tx) in pediatric solid-organ transplant recipients is the attainment of optimal final adult height. Except for kidney Tx there are limited data to address this issue. Remarkably similar factors impact on growth in pediatric kidney, liver, and heart recipients. Age is a primary factor, with younger recipients exhibiting the greatest immediate catch-up growth. Graft function is a significant contributory factor: a reduction in glomerular filtration rate (GFR) correlates with poor growth in kidney recipients, and the need for re-Tx is associated with impaired growth in liver recipients. The known adverse impact of corticosteroids on growth has led transplant physicians/surgeons to either modify the dose or attempt steroid withdrawal. In kidney and liver recipients this is associated with the development of acute rejection episodes. In infant heart transplant recipients the avoidance of maintenance corticosteroid immunosuppression is associated with normal growth velocity in the majority of recipients. With the marked improvement in patient and graft survival rates in pediatric solid-organ graft recipients, it is timely that the quality-of-life issues receive paramount attention. In children, normal growth following solid-organ Tx should be an achievable goal that results in normal final adult height.
小儿实体器官移植受者成功移植（Tx）的最终目标之一是达到最佳的最终成人身高。除肾脏移植外，解决这一问题的数据有限。显著相似的因素影响小儿肾脏、肝脏和心脏移植受者的生长。年龄是一个主要因素，年龄较小的受者表现出最大程度的即时追赶生长。移植肾功能是一个重要的促成因素：肾小球滤过率（GFR）降低与肾脏移植受者生长不良相关，而再次移植的需求与肝脏移植受者生长受损有关。皮质类固醇对生长的已知不利影响促使移植医生/外科医生要么调整剂量，要么尝试停用类固醇。在肾脏和肝脏移植受者中，这与急性排斥反应的发生有关。在婴儿心脏移植受者中，避免维持皮质类固醇免疫抑制与大多数受者的正常生长速度相关。随着小儿实体器官移植受者的患者和移植物存活率显著提高，生活质量问题应得到首要关注，这是适时的。在儿童中，实体器官移植后正常生长应该是一个可以实现的目标，从而实现正常的最终成人身高。
