Living related kidney donation as an advantage for growth of children independent of glomerular filtration rate.
Seventy-two pediatric kidney recipients of living related donors (LRD) and 145 of cadaveric donors (CAD) were analyzed for height standard deviation scores (Ht-SDS) and glomerular filtration rates (GFR) directly after transplantation and over the following 5 years. GFR was significantly higher immediately after transplantation in LRD compared with CAD recipients; however, GFR was not different during the 5-year follow-up period. Although Ht-SDS was comparable at the time of transplantation in both groups, it was significantly higher among LRD recipients over the next 5 years. Multivariate and covariate analyses showed that Ht-SDS after 5 years was mainly influenced only by CAD vs LRD and not by GFR or other factors, namely, donor age, rejections, time of dialysis, preemptive transplantation, age at transplantation, or immunosuppression. Thus, children receiving grafts from LRD showed a better catch-up growth independent of the GFR than those after CAD transplantation. We concluded that the period of donor death and prolonged cold ischemia in CAD grafts may lead to changes in gene expression of cytokines and other mediator molecules that affect bone metabolism. Better growth seems to be an additional factor supporting the policy of LRD kidney transplantation as the best option in children.
Pape
L
L
Department of Pediatric Nephrology, Medical School of Hannover, Hannover, Germany. larspape@t-online.de
Ehrich
J H H
JH
Zivicnjak
M
M
Offner
G
G
D000293:Adolescent; D002102:Cadaver; D002648:Child; D016207:Cytokines / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006128:Growth / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D019520:Living Donors / Q000523:psychology*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
D016207:Cytokines