Pediatric Nephrology

, Volume 26, Issue 6, pp 961–966

Growth of kidney-transplanted pediatric patients treated with sirolimus

  • David González
  • Clotilde D. García
  • Marta Azócar
  • Simon Waller
  • Angel Alonso
  • Gema Ariceta
  • Natalia Mejía
  • Fernando Santos
Original Article

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 failure Renal failure Sirolimus Rapamycin Kidney transplant Child 

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

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Copyright information

© IPNA 2011

Authors and Affiliations

  • David González
    • 1
  • Clotilde D. García
    • 2
  • Marta Azócar
    • 3
  • Simon Waller
    • 4
  • Angel Alonso
    • 5
  • Gema Ariceta
    • 6
  • Natalia Mejía
    • 7
  • Fernando Santos
    • 1
    • 8
  1. 1.Hospital Universitario Central de AsturiasOviedoSpain
  2. 2.Santo Antonio Children’s HospitalPorto AlegreBrazil
  3. 3.Hospital Luis Calvo MackennaSantiagoChile
  4. 4.Royal Sick Children’s HospitalGlasgowUnited Kingdom
  5. 5.Hospital Universitario La PazMadridSpain
  6. 6.Hospital de CrucesBaracaldoSpain
  7. 7.Hospital Universitario Fundación SantaféBogotaColombia
  8. 8.University of OviedoOviedoSpain

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