Adult height achieved in children after kidney transplantation
C. Aschendorff, G. Offner, L. Winkler, E. Schirg, P. F. Hoyer and J. Brodehl
Department of Pediatric Nephrology and Metabolic Disorders, Children's Hospital, Hannover, West Germany.
We evaluated posttransplantation growth, bone maturation, and adult height
in 20 adolescents who had received kidney transplants at the age of 10.5 to
17 years. Nine patients (five male, four female) were treated with
cyclosporine and low-dose prednisolone, and 11 children (six male, five
female) were treated with azathioprine and high-dose prednisolone. The
cumulative dose of steroids after transplantation was significantly lower
in the cyclosporine-treated group. Bone age, according to the
radius-ulna-short bones method of Tanner and Whitehouse, was almost the
same in both groups at the time of transplantation (15.0 and 14.6 years for
male subjects, 13.3 and 13.1 years for female subjects). Predicted adult
height (Tanner-Whitehouse Mark II-method of Tanner et al) and target height
were estimated at transplantation. Adult height was defined as achieved
when bone age in male subjects had reached 18 years and, in female
subjects, 16 years. Bone maturation of the cyclosporine-treated patients
occurred at a normal rate (0.92 bone-age years per chronologic year),
whereas the azathioprine-treated group exhibited a significantly slower
rate (0.56 bone-age years per chronologic year). The growth rate per year
for the cyclosporine-treated group was more than double that of the
azathioprine-treated group (3.0 cm vs 1.4 cm). The adult height of the
cyclosporine-treated group exceeded the predicted adult height by a mean of
1.3 cm, but the azathioprine-treated group missed it by 3.9 cm. Target
heights could not be achieved in any group. Kidney function was
significantly lower in the cyclosporine- vs the azathioprine-treated group,
but no patients suffered from severe renal insufficiency. We conclude that
cyclosporine and low-dose prednisolone are associated with normal bone
maturation and a better prognosis for final height in children with renal
transplants.
