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Early corticosteroid withdrawal is associated with improved adult height in pediatric kidney transplant recipients

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Abstract

Background

Catch-up growth after pediatric kidney transplantation (kTx) is usually insufficient to reach normal adult height. We aimed to analyze the effect of pre-transplant recombinant human growth hormone (rhGH) and corticosteroid withdrawal on linear growth in the first year after kidney transplantation and identify factors associated with final height (FH).

Methods

Patients who underwent kTx between 1996 and 2018 at below 18 years old in five Belgian and Dutch centers were included. We analyzed the differences between height Z-scores at kTx and 1 year post-transplant (Δ height Z-score) in children with and without corticosteroids at 1 year (CS + /CS −) and with and without rhGH treatment before kTx (rhGH + /rhGH −). Univariable and multivariable linear regression analysis was applied to identify factors associated with height Z-score at 1 year post-kTx, Δ height Z-score, and FH Z-score.

Results

A total of 177 patients were included, with median age 9.3 years at kTx. Median height Z-scores pre-kTx and 1 year later in the CS − /rhGH − , CS + /rhGH − , CS − /rhGH + , and CS + /rhGH + groups were − 1.42/ − 0.80, − 0.90/ − 0.62, − 1.35/ − 1.20, and − 1.30/ − 1.60 (p = 0.001). CS use 1 year post-kTx was the only factor associated with Δ height (p = 0.003) on multivariable analysis. CS use at 1 year was the only variable associated with FH (p = 0.014) in children with pre-transplant height Z-score below − 1 (n = 52).

Conclusions

Increase in height Z-score in the first year post-kTx was highest in the CS − /rhGH − group and lowest in the CS + /rhGH + group. The use of corticosteroids at 1 year post-kTx is associated with catch-up growth and in children with pre-transplant height Z-score below − 1 also with final height.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CKD:

Chronic kidney disease

kTx:

Kidney transplantation

NAPRTCS:

North American Pediatric Renal Trials and Collaborative Studies

SD:

Standard deviation

GH:

Growth hormone

IGF:

Insulin-like growth factor

rhGH:

Recombinant human growth hormone

PTLD:

Post-transplant lymphoproliferative disease

PTLD:

General Data Protection Regulation

BMI:

Body mass index

CKiD formula:

Chronic Kidney Disease in Children

eGFR:

Estimated glomerular filtration rate

CDG:

Congenital defect of glycosylation

CAKUT:

Congenital anomaly of the kidney or urinary tract

FSGS:

Focal segmental glomerulosclerosis

IQR:

Interquartile range

HUS:

Hemolytic uremic syndrome

CS:

Corticosteroids

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Acknowledgements

This study was supported by a research grant from Novo Nordisk.

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Authors and Affiliations

  1. Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium

    Gilles Tourlamain, Rani De Pauw, Karen Vanderstraeten, Amina El Amouri, Ann Raes & Agnieszka Prytuła

  2. Department of Pediatric Nephrology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands

    Mandy Keijzer-Veen

  3. Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands

    Antonia Bouts

  4. Department of Pediatric Nephrology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands

    Karlien Cransberg & Huib de Jong

  5. Department of Pediatric Nephrology, University Hospitals Leuven, Louvain, Belgium

    Noël Knops

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  1. Gilles Tourlamain
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Correspondence to Agnieszka Prytuła.

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Tourlamain, G., Keijzer-Veen, M., Bouts, A. et al. Early corticosteroid withdrawal is associated with improved adult height in pediatric kidney transplant recipients. Pediatr Nephrol 38, 279–289 (2023). https://doi.org/10.1007/s00467-022-05581-7

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  • DOI: https://doi.org/10.1007/s00467-022-05581-7

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