Franke Doris, Steffens Rena, Thomas Lena, Pavičić Leo, Ahlenstiel Thurid, Pape Lars, Gellermann Jutta, Müller Dominik, Querfeld Uwe, Haffner Dieter, Živičnjak Miroslav
Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
, Rendiceva 28B, 10000, Zagreb, Croatia.
Pediatr Nephrol. 2017 Mar;32(3):511-519. doi: 10.1007/s00467-016-3503-5. Epub 2016 Oct 21.
Children with chronic kidney disease are frequently born small for gestational age (SGA) and prone to disproportionately short stature. It is unclear how SGA affects growth after kidney transplantation (KTx).
Linear growth (height, sitting height, and leg length) was prospectively investigated in a cohort of 322 pediatric KTx recipients, with a mean follow-up of 4.9 years. Sitting height index (ratio of sitting height to total body height) was used to assess body proportions. Predictors of growth outcome in KTx patients with (n = 94) and without (n = 228) an SGA history were evaluated by the use of linear mixed-effects models.
Mean z-scores for all linear body dimensions were lower in SGA compared with non-SGA patients (p < 0.001). SGA patients presented with higher target height deficit and degree of body disproportion (p < 0.001). The latter was mainly due to reduced leg growth during childhood. Pubertal trunk growth was diminished in SGA patients, and the pubertal growth spurt of legs was delayed in both groups, resulting in further impairment of adult height, which was more frequently reduced in SGA than in non-SGA patients (50 % vs 18 %, p < 0.001). Use of growth hormone treatment in the pre-transplant period, preemptive KTx, transplant function, and control of metabolic acidosis were the only potentially modifiable correlates of post-transplant growth in SGA groups. By contrast, living related KTx, steroid exposure, and degree of anemia proved to be correlates in non-SGA only.
In children born SGA, growth outcome after KTx is significantly more impaired and affected by different clinical parameters compared with non-SGA patients.
慢性肾病患儿常常出生时小于胎龄（SGA），且容易出现身材比例失调性矮小。目前尚不清楚小于胎龄如何影响肾移植（KTx）后的生长情况。
前瞻性地研究了322名接受儿科肾移植受者队列的线性生长情况（身高、坐高和腿长），平均随访4.9年。使用坐高指数（坐高与全身身高的比值）评估身体比例。通过线性混合效应模型评估有（n = 94）和无（n = 228）小于胎龄病史的肾移植患者生长结局的预测因素。
与非小于胎龄患者相比，小于胎龄患者所有线性身体维度的平均z评分更低（p < 0.001）。小于胎龄患者的目标身高 deficit和身体比例失调程度更高（p < 0.001）。后者主要是由于儿童期腿部生长减少所致。小于胎龄患者青春期躯干生长减少，两组患者腿部青春期生长突增均延迟，导致成人身高进一步受损，小于胎龄患者中成人身高降低的情况比非小于胎龄患者更常见（50% 对18%，p < 0.001）。移植前使用生长激素治疗、抢先肾移植、移植功能和代谢性酸中毒的控制是小于胎龄组移植后生长的唯一潜在可改变相关因素。相比之下，活体亲属肾移植、类固醇暴露和贫血程度仅在非小于胎龄患者中被证明是相关因素。
与非小于胎龄患者相比，出生时小于胎龄的儿童肾移植后的生长结局明显更差，且受不同临床参数的影响。
