Tejani A, Cortes L, Sullivan E K
SUNY Health Science Center at Brooklyn, USA.
Kidney Int Suppl. 1996 Jan;53:103-8.
We have evaluated 587 patients with a functioning renal allograft for at least 54 months in whom baseline and continuous bi-annual height measurements were available. All height data were converted into SD score (SDS) or Z-score using normative tables. The results obtained in these patients were compared to our previous data collected at two years (N = 300) and three years (N = 412) post-transplantation. The demography of the study groups in the three time periods was similar. The height deficit in the first study was -2.41; it was -2.46 at the end of the second study period and was -2.29 at the end of the third study period. Children in the first study period had an improvement in height SDS (delta Z) of +0.18, of +0.16 in the second period, and of +0.11 at the end of the third study period. When improvement in height SD was evaluated by donor source, no differences were noted between living related and cadaver donor transplants. Analysis of height SDS by race revealed that, whereas for Caucasian children a steady improvement of 0.18 was noted during both second and third study periods, there was actual deceleration of growth for the African-American and Hispanic children at the end of the third study period (P < 0.02). Multivariate analysis showed that only initial height deficit and recipient age were independent predictors of improved height post-transplantation. Catch up growth, defined as an improvement of 1 SDS, was seen only in those with the greatest deficit or in children 0 to 1 year of age. Overall, catch up growth was seen in only 47% of 2 to 5 year olds. For children over the age of six years who form 72% of the total study cohort, little catch up growth was noted. Our long-term studies reveal that in the first years post-transplantation, when renal function is still stable, height acceleration does not occur in most of the children over the age of six years, and alternative strategies are necessary to improve the quality of life of these children.
我们评估了587例具有功能的同种异体肾移植患者，这些患者至少随访了54个月，且有基线和每两年一次的连续身高测量数据。所有身高数据均使用标准表格转换为标准差评分（SDS）或Z评分。将这些患者的结果与我们之前在移植后两年（N = 300）和三年（N = 412）收集的数据进行比较。三个时间段研究组的人口统计学特征相似。第一个研究中的身高 deficit为-2.41；在第二个研究期结束时为-2.46，在第三个研究期结束时为-2.29。第一个研究期的儿童身高SDS（Z值变化）改善了+0.18，第二个时期为+0.16，在第三个研究期结束时为+0.11。当按供体来源评估身高SD的改善情况时，活体亲属供体移植和尸体供体移植之间未发现差异。按种族分析身高SDS发现，虽然白种儿童在第二个和第三个研究期均有0.18的稳步改善，但非裔美国儿童和西班牙裔儿童在第三个研究期结束时实际生长减速（P < 0.02）。多变量分析表明，只有初始身高 deficit和受者年龄是移植后身高改善的独立预测因素。追赶生长定义为SDS改善1，仅在 deficit最大的患者或0至1岁的儿童中出现。总体而言，2至5岁儿童中只有47%出现追赶生长。对于占总研究队列72%的6岁以上儿童，几乎没有观察到追赶生长。我们的长期研究表明，在移植后的头几年，当肾功能仍稳定时，大多数6岁以上儿童不会出现身高加速，需要采取其他策略来改善这些儿童的生活质量。
