Strategies for optimizing growth in children with kidney transplants.
Children with a well-functioning graft continue to show growth retardation even with low-dose prednisone. We have attempted to utilize the steroid-sparing effect of cyclosporine by discontinuing prednisone after graft stabilization. Since 1983, 53 children have received cyclosporine as primary immunosuppressant for renal graft maintenance. The children, aged 6 months to 18 years, received 60 transplants. One-year and four-year patient survival for cadaveric transplants was 91% and 91%, compared with 96% and 96% for living related transplants. One-year and four-year graft survivals were 82% and 65% for cadaveric transplants (n = 25), compared with 91% and 63% for living related transplants (n = 35). Of 53 patients, 23 were able to discontinue prednisone and be maintained on monodrug cyclosporine therapy, and 21 of the 53 patients had growth hormone measured using L-dopa stimulation. In patients receiving more than 5 mg of prednisone daily, growth hormone levels were lower than normal (less than 10 ng/ml). Of 15 patients who had discontinued prednisone for more than 6 months, 13 showed accelerated growth by improvement in their standard deviation scores. In 4 pubescent children with growth retardation and need for maintenance prednisone, accelerated growth occurred following growth hormone administration for 3-6 months. Based on these data we suggest that (1) discontinuation of even very small doses of prednisone may be essential for normalizing growth hormone response to L-dopa and (2) further studies are needed to exploit the growth stimulation effect of recombinant growth hormone in transplanted children.
Tejani
A
A
Department of Pediatrics, State University of New York Health Science Center, Brooklyn 11203.
Butt
K M
KM
Rajpoot
D
D
Gonzalez
R
R
Buyan
N
N
Pomrantz
A
A
Sharma
R
R
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D013006:Growth Hormone / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use; D019382:Human Growth Hormone; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control; D011241:Prednisone / Q000627:therapeutic use; D011627:Puberty / Q000187:drug effects
D019382:Human Growth Hormone; D013006:Growth Hormone; D011241:Prednisone