Jung H W, Kim H Y, Lee Y A, Kang H G, Shin C H, Ha I S, Cheong H I, Yang S W
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Transplant Proc. 2013 Jan-Feb;45(1):108-14. doi: 10.1016/j.transproceed.2012.07.146.
Growth retardation is a common problem for children with chronic kidney disease. Although renal transplantation (RTx) resolves endocrine metabolic and uremic disturbances, growth continues to be suboptimal. This study aims to describe changes in height from diagnosis to final adult height (FAH) in Korean renal allograft recipients and determine factors associated with posttransplantation growth.
We retrospectively reviewed 63 renal allograft recipients who underwent RTx at <15 years of age with regular follow-up for >3 years afterwards. Pre- and post-RTx growth was analyzed by height Z scores (Ht_Z) at RTx, 2 and 5 years follow-up, and at FAH.
Ht_Z decreased from diagnosis to dialysis by -0.8 (P = .009) and from dialysis to RTx by -0.46 (P < .001). The mean baseline Ht_Z at RTx was -1.62 ± 1.36. The change in Ht_Z at 2 and 5 years after transplantation was 0.68 ± 0.88 and 0.48 ± 0.86, respectively. Both variables were negatively correlated with baseline age at RTx. Mean FAH was -1.22 ± 1.11 and was positively correlated with baseline height at RTx. Height at start of dialysis and dialysis duration were significant determinants of baseline height at RTx (P < .001).
Although there is significant posttransplant catch-up growth among younger recipients and among those with greater baseline height deficit, catch-up growth is not sustained and greater FAH is attained in those who are taller at RTx. Achieving greater height before dialysis and decreasing dialysis duration leads to maximal height at RTx as well as greater FAH.
生长发育迟缓是慢性肾脏病患儿的常见问题。尽管肾移植（RTx）可解决内分泌代谢和尿毒症紊乱问题，但生长发育仍不理想。本研究旨在描述韩国肾移植受者从诊断到最终成人身高（FAH）的身高变化，并确定与移植后生长相关的因素。
我们回顾性分析了63例15岁前接受RTx且术后定期随访超过3年的肾移植受者。通过RTx时、随访2年和5年以及达到FAH时的身高Z评分（Ht_Z）分析RTx前后的生长情况。
从诊断到透析，Ht_Z下降了-0.8（P = 0.009），从透析到RTx下降了-0.46（P < 0.001）。RTx时的平均基线Ht_Z为-1.62±1.36。移植后2年和5年Ht_Z的变化分别为0.68±0.88和0.48±0.86。这两个变量均与RTx时的基线年龄呈负相关。平均FAH为-1.22±1.11，与RTx时的基线身高呈正相关。透析开始时的身高和透析持续时间是RTx时基线身高的重要决定因素（P < 0.001）。
尽管年轻受者和基线身高缺陷较大的受者移植后有显著的追赶生长，但追赶生长并不持续，RTx时身高较高的受者可达到更高的FAH。在透析前达到更高的身高并缩短透析持续时间可使RTx时达到最大身高，同时也可获得更高的FAH。
