Pediatric Nephrology

, Volume 26, Issue 6, pp 961–966

Growth of kidney-transplanted pediatric patients treated with sirolimus

Authors

  • David González
    • Hospital Universitario Central de Asturias
  • Clotilde D. García
    • Santo Antonio Children’s Hospital
  • Marta Azócar
    • Hospital Luis Calvo Mackenna
  • Simon Waller
    • Royal Sick Children’s Hospital
  • Angel Alonso
    • Hospital Universitario La Paz
  • Gema Ariceta
    • Hospital de Cruces
  • Natalia Mejía
    • Hospital Universitario Fundación Santafé
    • Hospital Universitario Central de Asturias
    • University of Oviedo
Original Article

DOI: 10.1007/s00467-011-1811-3

Cite this article as:
González, D., García, C.D., Azócar, M. et al. Pediatr Nephrol (2011) 26: 961. doi:10.1007/s00467-011-1811-3

Abstract

Experimental findings indicate that sirolimus (SRL) inhibits longitudinal growth by mechanisms potentially related to its inhibitory effects on both cell proliferation and expression of vascular endothelial growth factor (VEGF). The aim of this study was to investigate the growth pattern of kidney-transplanted children treated with SRL in a multicenter observational clinical study. Height, change in height SD (Δ height) and growth velocity of pediatric patients with renal transplant were calculated at 0, 6, 12, and 24 months after starting SRL. Controls of kidney-transplanted children not treated with SRL were matched by age, gender, renal function, and dose of corticosteroids. Sixty-eight children (34 SRL, 34 controls) were enrolled in the study. Nephrotoxicity was the most frequent indication to start therapy with SRL. SRL exerted an adverse effect on growth as demonstrated by significantly lower (p < 0.05) growth velocity (cm/year) and smaller change in height SD in the SRL group after 6 (4.08 vs. 6.56 and –0.05 vs. 0.14), 12 (4.44 vs. 6.11 and –0.03 vs. 0.28) and 24 (4.53 vs. 6.03 and –0.04 vs. 0.53) months of treatment. This study suggests that SRL therapy may interfere with growth of kidney-transplanted children. This undesirable effect needs to be taken into account when considering a switch to SRL and confirmed in further prospective trials including larger number of patients.

Keywords

Growth failureRenal failureSirolimusRapamycinKidney transplantChild

Abbreviations

SRL

Sirolimus

GFR

Glomerular filtration rate

mTOR

Mammalian target of rapamycin

VEGF

Vascular endothelial growth factor

Δ Height

Change in height SD

CNIs

Calcineurin inhibitors

rhGH

Recombinant human growth hormone

Copyright information

© IPNA 2011