Early corticosteroid withdrawal is associated with improved adult height in pediatric kidney transplant recipients
Gilles Tourlamain1, Mandy Keijzer-Veen 2, Antonia Bouts3, Karlien Cransberg4, Huib de Jong4, Rani De Pauw 1, Karen Vanderstraeten1, Amina El Amouri 1, Ann Raes1, Noël Knops5, Agnieszka Prytula1.
1Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium; 2Pediatric Nephrology, Wilhelmina Children's Hospital, Utrecht, Netherlands; 3Pediatric Nephrology, Emma Children’s Hospital, Amsterdam, Netherlands; 4Pediatric Nephrology, Erasmus Medical Center- Sophia Children’s Hospital, Rotterdam, Netherlands; 5Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
Objectives: We aimed to analyze the effect of pretransplant recombinant human growth hormone (rhGH) and corticosteroid withdrawal on longitudinal growth in the 1st year after kidney transplantation (kTx) and to identify factors associated with final height (FH) in pediatric kTx recipients.
Methods: Patients who underwent kTx between 1996 and 2018 in 5 Belgian and Dutch centers before the age of 18 yrs were included in this retrospective study. We analyzed the differences between height SDS at kTx and 1 year after kTx (Δ height SDS) in children with and without corticosteroids at 1 year (CS+ /CS-) and who were and were not treated with rhGH before kTx (rhGH+ /rhGH-). Univariate and multivariate linear regression analysis was performed to identify factors associated with height SDS at 1 year post-kTx, Δ height SDS and FH SDS.
Results: 177 patients were included, with median age 9.3 years at kTx. The median height SDS before kTx and 1 year after kTx 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). Corticosteroid use at 1 year post-kTx was the only factor associated with Δ height on multivariate analysis (p=0.003). Median FH SDS, available in 124 patients, was -0.80 (range:-7.30-3.10). There was an association between FH and Δ height SDS at 1 year (p<0.001). Of 96 patients with height SDS <-1 at 1 year, 64 had FH <-1 SDS. Corticosteroid dose at 1 year was associated with FH on multivariate analysis (p=0.014).
Conclusions: Growth in the first year after 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 the most important factor associated with growth in children in the 1st year after kTx and final height.