Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Orthopedic Surgery, Vivantes Auguste-Viktoria-Hospital, Rubensstr. 125, 12157, Berlin, Germany.
Pediatr Nephrol. 2021 Jul;36(7):1871-1880. doi: 10.1007/s00467-021-04922-2. Epub 2021 Feb 23.
Short stature is a frequent complication after pediatric kidney transplantation (KT). Whether the type of transplantation and prior treatment with recombinant human growth hormone (GH) affects post-transplant growth, is unclear.
Body height, leg length, sitting height, and sitting height index (as a measure of body proportions) were prospectively investigated in 148 prepubertal patients enrolled in the CKD Growth and Development study with a median follow-up of 5.0 years. We used linear mixed-effects models to identify predictors for body dimensions.
Pre-transplant Z scores for height (- 2.18), sitting height (- 1.37), and leg length (- 2.30) were reduced, and sitting height index (1.59) was increased compared to healthy children, indicating disproportionate short stature. Catch-up growth in children aged less than 4 years was mainly due to stimulated trunk length, and in older children to improved leg length, resulting in normalization of body height and proportions before puberty in the majority of patients. Use of GH in the pre-transplant period, congenital CKD, birth parameters, parental height, time after KT, steroid exposure, and transplant function were significantly associated with growth outcome. Although, unadjusted growth data suggested superior post-transplant growth after (pre-emptive) living donor KT, this was no longer true after adjusting for the abovementioned confounders.
Catch-up growth after KT is mainly due to stimulated trunk growth in young children (< 4 years) and improved leg growth in older children. Beside transplant function, steroid exposure and use of GH in the pre-transplant period are the main potentially modifiable factors associated with better growth outcome.
身材矮小是儿科肾移植（KT）后常见的并发症。移植类型和重组人生长激素（GH）治疗是否影响移植后的生长尚不清楚。
在 CKD 生长与发育研究中，前瞻性地调查了 148 名处于青春前期的患者的身高、腿长、坐高和坐高指数（作为身体比例的衡量标准），中位随访时间为 5.0 年。我们使用线性混合效应模型来确定身体维度的预测因素。
与健康儿童相比，移植前身高（-2.18）、坐高（-1.37）和腿长（-2.30）的 Z 分数降低，坐高指数（1.59）升高，表明身材比例不均。4 岁以下儿童的追赶性生长主要是由于刺激了躯干长度，而较大儿童则是由于腿长的改善，导致大多数患者在青春期前身高和比例恢复正常。移植前使用 GH、先天性慢性肾脏疾病、出生参数、父母身高、KT 后时间、皮质类固醇暴露和移植功能与生长结果显著相关。尽管未调整的生长数据表明（预防性）活体供者 KT 后移植后生长较好，但在调整上述混杂因素后，这一结果不再成立。
KT 后的追赶性生长主要是由于年幼儿童（<4 岁）的躯干生长刺激和较大儿童的腿长改善。除移植功能外，皮质类固醇暴露和移植前使用 GH 是与更好生长结果相关的主要潜在可调节因素。
