title: Kidney transplantation fails to provide adequate growth in children with chronic kidney disease born small for gestational age.
abstract: Children with chronic kidney disease are frequently born small for gestational age (SGA) and prone to disproportionately short stature. It is unclear how SGA affects growth after kidney transplantation (KTx).
  
  
  
  Linear growth (height, sitting height, and leg length) was prospectively investigated in a cohort of 322 pediatric KTx recipients, with a mean follow-up of 4.9 years. Sitting height index (ratio of sitting height to total body height) was used to assess body proportions. Predictors of growth outcome in KTx patients with (n = 94) and without (n = 228) an SGA history were evaluated by the use of linear mixed-effects models.
  
  
  
  Mean z-scores for all linear body dimensions were lower in SGA compared with non-SGA patients (p < 0.001). SGA patients presented with higher target height deficit and degree of body disproportion (p < 0.001). The latter was mainly due to reduced leg growth during childhood. Pubertal trunk growth was diminished in SGA patients, and the pubertal growth spurt of legs was delayed in both groups, resulting in further impairment of adult height, which was more frequently reduced in SGA than in non-SGA patients (50 % vs 18 %, p < 0.001). Use of growth hormone treatment in the pre-transplant period, preemptive KTx, transplant function, and control of metabolic acidosis were the only potentially modifiable correlates of post-transplant growth in SGA groups. By contrast, living related KTx, steroid exposure, and degree of anemia proved to be correlates in non-SGA only.
  
  
  
  In children born SGA, growth outcome after KTx is significantly more impaired and affected by different clinical parameters compared with non-SGA patients.
authors: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors: Doris
authors: D
authors: Franke
authors: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors: Rena
authors: R
authors: Steffens
authors: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors: Lena
authors: L
authors: Thomas
authors: , Rendiceva 28B, 10000, Zagreb, Croatia.
authors: Leo
authors: L
authors: Pavičić
authors: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors: Thurid
authors: T
authors: Ahlenstiel
authors: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors: Lars
authors: L
authors: Pape
authors: Department of Pediatric Nephrology, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany.
authors: Jutta
authors: J
authors: Gellermann
authors: Department of Pediatric Nephrology, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany.
authors: Dominik
authors: D
authors: Müller
authors: Department of Pediatric Nephrology, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany.
authors: Uwe
authors: U
authors: Querfeld
authors: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors: Dieter
authors: D
authors: Haffner
authors: Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. zivicnjak.miroslav@mh-hannover.de.
authors: Miroslav
authors: M
authors: Živičnjak
mesh_terms: D000293:Adolescent; D000375:Aging; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006128:Growth; D006130:Growth Disorders / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016030:Kidney Transplantation / Q000379:methods*; D007866:Leg / Q000254:growth & development; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012741:Sexual Maturation; D013909:Thorax / Q000254:growth & development
keywords: Anthropometry; Children; Chronic kidney disease; Growth; Kidney transplantation; Small for gestational age