Vester Udo, Schaefer Antonia, Kranz Birgitta, Wingen Anne-Margret, Nadalin Silvio, Paul Andreas, Malagò Massimo, Broelsch Christoph E, Hoyer Peter F
Clinic of Pediatric Nephrology, University of Duisburg-Essen, Essen, Germany.
Pediatr Transplant. 2005 Aug;9(4):445-9. doi: 10.1111/j.1399-3046.2005.00304.x.
Suboptimal final height and marked weight gain after renal transplantation (RTx) are common and may result in obesity. Steroid free immunosuppression has been advocated to improve growth and limit weight gain. We evaluated retrospectively the evolution of growth and body mass index (BMI) after renal transplantation to study risk factors for weight gain under steroid based treatment. Sixty-four pediatric patients (age 9.9 +/- 5.0 yr) were included in the study. To allow comparison between different age groups, standard deviation scores (SDS) for height and BMI for height age were calculated at time of transplantation and 3, 6, 9, 12, 24, 36, 48 and 60 months later. Induction immunosuppression consisted of basiliximab, cyclosporine and prednisone. Growth retardation at time of RTx was obvious with a SDS for height of -2.20 +/- 1.34. Height during the first year improved to an SDS of -2.0 +/- 1.27 (p < 0.01) but did further not increase in year 2 and 3. More than 40% of all patients remained 2 SDS below normal mean. SDS BMI for height age at transplantation was -0.19 +/- 0.98 and increased significantly during the first 3 months after transplantation to +0.64 +/- 1.07 (p < 0.01). Thereafter, BMI remained stable but did not decline to pretransplant values. A SDS BMI for height age of more than 2 SDS was observed in 2, 6, 9 and 11% of children at RTx and 1, 2 and 3 yr later respectively. BMI gain over 3 yr was significantly enhanced in children whose parents (especially the mother) were overweight. No influence of gender, BMI at RTx, dialysis modality prior to RTx or rejection episodes could be detected. We conclude that after RTx children exhibit some improvement in growth but height remains suboptimal. The BMI does increase significantly during the first months after RTx and does not return to baseline values under steroid-based immunosuppression. Obesity (>2 SDS above normal) does not occur more often than in the normal population. The most predictive parameter of inappropriate weight gain during 3 yr is the BMI of the mother. We would speculate that steroids may play a major role in weight gain in the early phase after RTx. However, genetic or environmental factors predict the long-term weight development.
肾移植（RTx）后最终身高未达最佳水平以及体重显著增加很常见，且可能导致肥胖。有人主张采用无类固醇免疫抑制来促进生长并限制体重增加。我们回顾性评估了肾移植后生长和体重指数（BMI）的变化情况，以研究基于类固醇治疗下体重增加的风险因素。64例儿科患者（年龄9.9±5.0岁）被纳入研究。为便于不同年龄组之间进行比较，在移植时以及移植后3、6、9、12、24、36、48和60个月计算身高标准差评分（SDS）以及身高年龄对应的BMI。诱导免疫抑制方案包括巴利昔单抗、环孢素和泼尼松。肾移植时生长迟缓明显，身高SDS为-2.20±1.34。第一年身高改善至SDS为-2.0±1.27（p<0.01），但在第2年和第3年未进一步增加。超过40%的患者身高仍比正常均值低2个标准差。移植时身高年龄对应的BMI SDS为-0.19±0.98，移植后前3个月显著增加至+0.64±1.07（p<0.01）。此后，BMI保持稳定，但未降至移植前水平。肾移植时以及移植后1、2和3年，分别有2%、6%、9%和11%的儿童身高年龄对应的BMI SDS超过2个标准差。父母（尤其是母亲）超重的儿童3年内BMI增加显著增强。未检测到性别、肾移植时的BMI、肾移植前的透析方式或排斥反应的影响。我们得出结论，肾移植后儿童生长有一定改善，但身高仍未达最佳水平。肾移植后最初几个月BMI显著增加，在基于类固醇的免疫抑制下未恢复至基线值。肥胖（比正常高>2个标准差）的发生率并不高于正常人群。3年内体重增加不当的最具预测性参数是母亲的BMI。我们推测类固醇可能在肾移植后早期体重增加中起主要作用。然而，遗传或环境因素可预测长期体重发展。
