Somatic growth after kidney transplantation. Beneficial effect of cyclosporine in comparison with conventional immunosuppression

G. Offner, P. F. Hoyer, H. Juppner, H. P. Krohn and J. Brodehl

Growth performance was evaluated in 69 children, aged 3 to 16 years, who had undergone kidney transplantation between 1974 and 1984. Forty children (21 boys, 19 girls) who received transplants before September 1982 were treated conventionally with azathioprine and high-dose prednisolone; 29 children (13 boys, 16 girls) who received transplants after September 1982 were treated with cyclosporine and low-dose prednisolone. The mean (+/- SD) survival times of grafts in the azathioprine and cyclosporine groups were 6.0 +/- 2.1 years and 1.4 +/- 0.5 years, respectively. Height and bone age were evaluated at the time of transplantation, one year after transplantation, and at reevaluation in December 1985. Growth rates expressed by standard deviation scores (SDS) declined in the azathioprine group for boys (mean, -2.2 at transplantation, -2.5 after one year, and -2.8 in December 1985) and girls (-2.1, -2.4, and -2.7) and improved in the cyclosporine group for boys (-2.5, -2.2, and -2.1) and girls (-2.2, -1.9, and -1.8). The difference between both groups one year after transplantation was significant. This trend continued beyond the first year after transplantation. Graft function was better in the azathioprine group than in the cyclosporine group. Bone age in December 1985 was less retarded in the cyclosporine group, but this could have been related to the shorter observation time. We conclude that somatic growth after kidney transplantation is below expected rates under azathioprine-prednisolone immunosuppression but is significantly better under cyclosporine-prednisolone immunosuppression.