Effects of growth hormone in short children after renal transplantation. French Society of Pediatric Nephrology.
From 1991 to 1993, 90 children having received a kidney graft with a post-transplantation period of at least 12 months were included in a prospective study carried out in 18 French pediatric centers. After informed consent and randomization, children received recombinant human growth hormone (rhGH) (Genotonorm, Pharmacia peptide hormones) 30 U/m2 per week, either immediately on enrollment, for the treated group, or after 1 year of follow-up for the group serving as a control. After 1 year both groups were treated and we analyzed data during the subsequent years. Eighty-five children completed the 1-year study. Growth velocity was significantly increased by rhGH: 7.7 cm with a gain of +0.3 standard deviation score in the treated group versus 4.6 cm in the control group (P<0.0001) during the 1st year. Four factors predicted response to therapy: growth velocity prior to GH therapy, glomerular filtration rate (GFR) at the start, mode of corticosteroid administration, and degree of insulin resistance. After 1 year we observed a moderate, significant decrease in GFR in both groups. Biopsy-proven acute rejection episodes were not significantly more frequent during the 1st year in the group of patients who received rhGH: 9 in 44 versus 4 in 46 patients. The patients who rejected did not differ in terms of age, renal function at the start, and type of immunosuppression, but history of rejection before GH treatment was discriminatory: 6 of 17 children with two or more episodes had a new rejection versus 1 of 22 who had no or only one episode (P=0.01). Glucose tolerance was not modified after 1 year of GH therapy. During the subsequent years of treatment a decrease in growth velocity was noted: 5.9 cm at 2 years, 5.5 at 3 years, and 5.2 cm at 4 years. In conclusion, GH is efficient for improving growth velocity in short transplanted children, inducing clear-cut but limited catch-up growth. The risk of rejection was shown only in patients with a prior history of more than one rejection episode.
Guest
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G
Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France.
Bérard
E
E
Crosnier
H
H
Chevallier
T
T
Rappaport
R
R
Broyer
M
M
D000293:Adolescent; D002118:Calcium / Q000097:blood; D002648:Child; D004311:Double-Blind Method; D005260:Female; D005951:Glucose Tolerance Test; D006084:Graft Rejection / Q000209:etiology / Q000503:physiopathology; D006128:Growth / Q000187:drug effects; D006130:Growth Disorders / Q000188:drug therapy*; D019382:Human Growth Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D010758:Phosphorus / Q000097:blood; D011627:Puberty / Q000187:drug effects; D014807:Vitamin D / Q000097:blood
D019382:Human Growth Hormone; D014807:Vitamin D; D010758:Phosphorus; D002118:Calcium