Growth after renal transplantation
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EDUCATIONAL REVIEW
Growth after renal transplantation Jérôme Harambat & Pierre Cochat
Received: 31 August 2007 / Revised: 30 January 2008 / Accepted: 1 February 2008 / Published online: 26 March 2008 # IPNA 2008
Abstract Growth may be severely impaired in children with chronic renal insufficiency. Since short stature can have major consequences on quality of life and self-esteem, achieving a ‘normal’ height is a crucial issue for renal transplant recipients. However, despite successful renal transplantation, the final height attained by most recipients is not the calculated target height. Catch-up growth spurts post-transplantation are usually insufficient to compensate for the retardation in growth that has occurred during the pretransplant period. Longitudinal growth post-transplantation is therefore influenced by the age at transplantation but also by subsequent allograft function and steroid exposure, both of which interfere with the growth hormone/insulin-like growth factor axis. The management of growth retardation in renal transplant recipients includes adequate nutritional intake, correction of metabolic acidosis, prevention of bone disease, steroid-sparing strategies and a supraphysiological dose of recombinant human growth hormone in selected cases. Keywords Children . Corticosteroids . Growth . Growth hormone . Quality of life . Renal transplantation
Introduction One of the goals of renal transplantation in children is to restore an optimal quality of life (QOL), including the J. Harambat : P. Cochat Département de Pédiatrie and Inserm U820, Hôpital Edouard-Herriot and Université Claude-Bernard Lyon 1, Lyon, France P. Cochat (*) Département de Pédiatrie, Unité de Néphrologie Pédiatrique, Hôpital Edouard Herriot, place d’Arsonval, 69437 Lyon, France e-mail: [email protected]
optimization of final height. However, catch-up growth post-transplantation is generally not sufficient to compensate for the deficit that has been acquired during the pretransplant period. Growth retardation post-transplantation is multifactorial and associated with impaired medical and psychosocial outcomes. Despite numerous recent developments in pediatric renal transplantation, achieving an adequate final height remains a challenging issue for such recipients.
Growth assessment Growth assessment and management should be performed in any pediatric transplant recipient [1]. Anthropometric parameters, including height, body weight, body mass index (plus head circumference in children less than 3 years of age), should be monitored every 3 months in children less than 3 years of age, then every 6 months until final height is reached. Final height is reached as the growth velocity per year minus 1–2 cm after puberty has occurred. The target height (H, in cm) is based on mid-parental height (girls = [Hmother + Hfather–13]/2; boys = [Hmother + Hfather + 13]/2) according to Tanner method [2]. A more recent formula based on parental height standard deviation score (SDS) and independent of sex has been proposed [3]. Growth parame
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