Tourlamain Gilles, Keijzer-Veen Mandy, Bouts Antonia, Cransberg Karlien, de Jong Huib, De Pauw Rani, Vanderstraeten Karen, El Amouri Amina, Raes Ann, Knops Noël, Prytuła Agnieszka
Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium.
Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
Pediatr Nephrol. 2023 Jan;38(1):279-289. doi: 10.1007/s00467-022-05581-7. Epub 2022 Apr 28.
Catch-up growth after pediatric kidney transplantation (kTx) is usually insufficient to reach normal adult height. We aimed to analyze the effect of pre-transplant recombinant human growth hormone (rhGH) and corticosteroid withdrawal on linear growth in the first year after kidney transplantation and identify factors associated with final height (FH).
Patients who underwent kTx between 1996 and 2018 at below 18 years old in five Belgian and Dutch centers were included. We analyzed the differences between height Z-scores at kTx and 1 year post-transplant (Δ height Z-score) in children with and without corticosteroids at 1 year (CS + /CS -) and with and without rhGH treatment before kTx (rhGH + /rhGH -). Univariable and multivariable linear regression analysis was applied to identify factors associated with height Z-score at 1 year post-kTx, Δ height Z-score, and FH Z-score.
A total of 177 patients were included, with median age 9.3 years at kTx. Median height Z-scores pre-kTx and 1 year later in the CS - /rhGH - , CS + /rhGH - , CS - /rhGH + , and CS + /rhGH + groups were - 1.42/ - 0.80, - 0.90/ - 0.62, - 1.35/ - 1.20, and - 1.30/ - 1.60 (p = 0.001). CS use 1 year post-kTx was the only factor associated with Δ height (p = 0.003) on multivariable analysis. CS use at 1 year was the only variable associated with FH (p = 0.014) in children with pre-transplant height Z-score below - 1 (n = 52).
Increase in height Z-score in the first year post-kTx was highest in the CS - /rhGH - group and lowest in the CS + /rhGH + group. The use of corticosteroids at 1 year post-kTx is associated with catch-up growth and in children with pre-transplant height Z-score below - 1 also with final height. A higher resolution version of the Graphical abstract is available as Supplementary information.
小儿肾移植（kTx）后的追赶生长通常不足以达到正常成人身高。我们旨在分析移植前重组人生长激素（rhGH）和停用皮质类固醇对肾移植后第一年线性生长的影响，并确定与最终身高（FH）相关的因素。
纳入1996年至2018年在比利时和荷兰五个中心接受kTx时年龄小于18岁的患者。我们分析了肾移植时和移植后1年身高Z评分的差异（Δ身高Z评分），分为移植后1年使用皮质类固醇和未使用皮质类固醇的儿童（CS +/CS -）以及移植前使用和未使用rhGH治疗的儿童（rhGH +/rhGH -）。应用单变量和多变量线性回归分析来确定与肾移植后1年身高Z评分、Δ身高Z评分和FH Z评分相关的因素。
共纳入177例患者，肾移植时中位年龄为9.3岁。CS -/rhGH -、CS +/rhGH -、CS -/rhGH +和CS +/rhGH +组肾移植前和1年后的中位身高Z评分分别为-1.42/-0.80、-0.90/-0.62、-1.35/-1.20和-1.30/-1.60（p = 0.001）。多变量分析显示，移植后1年使用皮质类固醇是与Δ身高相关的唯一因素（p = 0.003）。对于移植前身高Z评分低于-1的儿童（n = 52），移植后1年使用皮质类固醇是与FH相关的唯一变量（p = 0.014）。
肾移植后第一年身高Z评分的增加在CS -/rhGH -组中最高，在CS +/rhGH +组中最低。移植后1年使用皮质类固醇与追赶生长相关，对于移植前身高Z评分低于-1的儿童，还与最终身高相关。更高分辨率的图形摘要可作为补充信息获取。
