Growth after renal transplantation in infancy or early childhood

Forty-one children <5 years of age at kidney transplantation (TX) were investigated for growth, bone age, and renal function up to 7 years (n=26) after TX. All children received triple immunosuppression, including alternate-day corticosteroid treatment. Catch-up growth was seen in 81% of 30 children without growth hormone (GH) treatment. Children <2 years of age without GH had a mean height standard deviation score (hSDS) of -1.1 +/- 0.8 at TX and -1.1 +/- 0.5 at 7 years; children between 2 and 5 years improved their hSDS from -1.9 +/- 0.9 to -0.4 +/- 0.8 (P<0.0001). The hSDS at TX correlated inversely with the DeltahSDS from TX to 7 years (r=-0.80, P=0.0002). Glomerular filtrations rate (GFR) at 5 years post TX correlated with the subsequent growth rate from 5 to 7 years TX (r=0.58, P=0.01). Catch-up growth was seen in all 11 children receiving GH. Their mean hSDS improved from -2.5 +/- 0.9 to -1.1 +/- 0.9 (P<0.0001). In the majority of children receiving a kidney graft in early life, triple immunosuppression with alternate-day steroids can ensure catch-up growth. In children <5 years of age at TX, growth is predicted better by the degree of stunting than by age.