Growth Following Pediatric Heart Transplantation
Orthotopic heart transplantation is an accepted therapy in children for a variety of cardiac conditions including congenital heart disease and cardiomyopathies, both congenital and acquired. Post-transplant mortality continues to decrease, and as it does the challenges of preventing a variety of morbidities increase. Somatic growth is negatively affected in these patients both pre- and post-transplantation and can be an important morbidity. While data regarding growth in this population are limited, there are a growing number of studies which add to our knowledge and confirm suspicions that these patients are at high risk for impaired growth. Children requiring heart transplantation are often small for age prior to transplant and remain at risk for continued poor growth following transplant. Disordered growth can occur in all parameters: weight, height/length, and body mass index. Potential etiologies of post-transplant growth difficulties include underlying disease, medications used in the care of transplant recipients, and continued chronic complications. Different protocols for use of corticosteroids complicate interpretation and comparison of studies of growth following heart transplantation in children. However, the overall trend following transplantation is the long-term restoration of weight, and to a lesser extent height, to the normal range. Children undergoing heart transplantation exhibit “catch-up growth” early after transplantation, but remain shorter than their age-matched peers. Children with the greatest deficits in growth prior to transplantation show the greatest improvement after transplantation.
KeywordsCongenital Heart Disease Growth Velocity Hypoplastic Left Heart Syndrome Noonan Syndrome Heart Transplant Recipient
Body mass index
Congenital heart disease
Orthotopic heart transplantation
Pediatric Heart Transplant Study Group