Early corticosteroid withdrawal is associated with improved adult height in pediatric kidney transplant recipients.

Abstract

Catch-up growth after pediatric kidney transplantation (kTx) is usually insufficient to reach normal adult height. We aimed to analyze the effect of pre-transplant recombinant human growth hormone (rhGH) and corticosteroid withdrawal on linear growth in the first year after kidney transplantation and identify factors associated with final height (FH). Patients who underwent kTx between 1996 and 2018 at below 18years old in five Belgian and Dutch centers were included. We analyzed the differences between height Z-scores at kTx and 1year post-transplant (Δ height Z-score) in children with and without corticosteroids at 1year (CS + /CS -) and with and without rhGH treatment before kTx (rhGH + /rhGH -). Univariable and multivariable linear regression analysis was applied to identify factors associated with height Z-score at 1year post-kTx, Δ height Z-score, and FH Z-score. A total of 177 patients were included, with median age 9.3years at kTx. Median height Z-scores pre-kTx and 1year later in the CS - /rhGH - , CS + /rhGH - , CS - /rhGH + , and CS + /rhGH + groups were - 1.42/ - 0.80, - 0.90/ - 0.62, - 1.35/ - 1.20, and - 1.30/ - 1.60 (p = 0.001). CS use 1year post-kTx was the only factor associated with Δ height (p = 0.003) on multivariable analysis. CS use at 1year was the only variable associated with FH (p = 0.014) in children with pre-transplant height Z-score below - 1 (n = 52). Increase in height Z-score in the first year post-kTx was highest in the CS - /rhGH - group and lowest in the CS + /rhGH + group. The use of corticosteroids at 1year post-kTx is associated with catch-up growth and in children with pre-transplant height Z-score below - 1 also with final height. A higher resolution version of the Graphical abstract is available as Supplementary information.