Abstract
Background
Growth hormone had been applied to treat pediatric renal allograft recipients with growth retardation. In this systemic review and meta-analysis, we assess the efficiency and safety of growth hormone use in post-renal transplant children.
Methods
A literature search revealed five prospective randomized controlled trials assessing this therapy, with a total of 401 patients. The outcomes, including the baseline height standard deviation score (HSDS), HSDS after a 1-year therapy, delta height standard deviation score (△HSDS), allograft rejection rates and changes in the glomerular filtration rates (GFR) were analyzed.
Results
Pooled data of the five studies showed that 1 year after the randomized controlled trials, the experimental group receiving growth hormone had a significantly higher growth velocity than the control group, with a mean HSDS difference of 0.68 [95 % confidence interval (CI) 0.25–1.11, P = 0.002] between the two groups. The mean difference in the △HSDS between the treated and control group was 0.52 (95 % CI 0.37–0.68, P < 0.00001). The rejection episode rates were 35/205 and 19/185, respectively (number of patients with rejection/ total number of patients) (risk ratio 1.56, 95 % CI 0.97–2.53, P = 0.07), and the mean difference in the △GFR was 3.27 ml/min per 1.73 m2 (95 % CI −3.54–10.09, P = 0.35), which was not statistically significant.
Conclusions
Based on these studies, we suggest that the application of growth hormone is an effective treatment to promote the growth velocity of children after kidney transplantation. However, the safety of this treatment needs further evaluation.
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References
McEnery PT, Alexander SR, Sullivan K, Tejani A (1993) Renal transplantation in children and adolescents: the 1992 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 7:711–720
McEnery PT, Stablein DM, Arbus G, Tejani A (1992) Renal transplantation in children. A report of the North American Pediatric Renal Transplant Cooperative Study. N Engl J Med 326:1727–1732
Feld LG, Stablein D, Fivush B, Harmon W, Tejani A (1997) Renal transplantation in children from 1987–1996: the 1996 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Transplant 1:146–162
Gulati A, Sarwal MM (2010) Pediatric renal transplantation: an overview and update. Curr Opin Pediatr 22:189–196
Hokken-Koelega AC, van Zaal MA, van Bergen W, de Ridder MA, Stijnen T, Wolff ED, de Jong RC, Donckerwolcke RA, de Muinck Keizer-Schrama SM, Drop SL (1994) Final height and its predictive factors after renal transplantation in childhood. Pediatr Res 36:323–328
Hokken-Koelega AC, Van Zaal MA, de Ridder MA, Wolff ED, De Jong MC, Donckerwolcke RA, De Muinck Keizer-Schrama SM, Drop S (1994) Growth after renal transplantation in prepubertal children: impact of various treatment modalities. Pediatr Res 35:367–371
Messa P, Sindici C, Cannella G, Miotti V, Risaliti A, Gropuzzo M, Di Loreto PL, Bresadola F, Mioni G (1998) Persistent secondary hyperparathyroidism after renal transplantation. Kidney Int 54:1704–1713
Kiepe D, Rüth EM, Blum WF, Mohan S, Weber LT, Tonshoff B (2010) The IGF/IGFBP system in relation to macroscopic bone architecture in pediatric renal transplant patients. Pediatr Nephrol 25:659–667
Ingulli E, Singh A, Moazami S, Tejiani A (1993) Prednisone inhibits the efficacy of recombinant human growth hormone in pediatric renal transplant recipients. Kidney Int 44:65–70
Castañeda DA, López LF, Ovalle DF, Buitrago J, Rodríguez D, Lozano E (2011) Growth, chronic kidney disease and pediatric kidney transplantation: is it useful to use recombinant growth hormone in Colombian children with renal transplant. Transplant Proc 43:3344–3349
Broyer M (1996) Results and side-effects of treating children with growth hormone after kidney transplantation—a preliminary report. Acta Pediatr Suppl 417:76–79
Guest G, Bérard E, Crosnier H, Chevallier T, Rappaport R, Broyer M (1998) Effects of growth hormone in short children after renal transplantation. Pediatr Nephrol 12:437–446
Maxwell H, Rees L (1998) Randomised controlled trial of recombinant human growth hormone in prepubertal and pubertal renal transplant recipients. Arch Dis Child 79:481–487
Fine RN, Stablein D, Cohen AH, Tejani A, Kohaut E (2002) Recombinant human growth hormone post-renal transplantation in children: a randomized controlled study of the NAPRTCS. Kidney Int 62:688–696
Sanchez CP, Kuizon BD, Goodman WG, Gales B, Ettenger RB, Inez Boechat M, Wang Y, Elashoff R, Salusky IB (2002) Growth hormone and the skeleton in pediatric renal allograft recipients. Pediatr Nephrol 17:322–328
Kelley KW (1989) Growth hormone, lymphocytes and macrophages. Biochem Pharmacol 38:705–713
Tyden G, Berg U, Reinholt F (1990) Acute renal graft rejection after treatment with human growth hormone. Lancet 336:1455–1456
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Wu, Y., Cheng, W., Yang, Xd. et al. Growth hormone improves growth in pediatric renal transplant recipients—a systemic review and meta-analysis of randomized controlled trials. Pediatr Nephrol 28, 129–133 (2013). https://doi.org/10.1007/s00467-012-2208-7
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DOI: https://doi.org/10.1007/s00467-012-2208-7