PRIOR rhGH AND RENAL TRANSPLANT FUNCTION

Abstract

895 Objective: To evaluate post transplant outcomes for patients treated with human growth hormone (rhGH) during the course of chronic renal insufficiency (CRI). Outcomes evaluated include patient survival, graft survival, incidence of acute rejection episodes (ARE), frequency of adverse events, and the occurrence of "catch down" growth. Study Design: One hundred and two patients (the "cohort" group) were identified who had been enrolled in two controlled studies to determine the efficacy and safety of rhGH in growth retarded children with CRI and (b) were subsequently enrolled in the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) and received a renal transplant. Patient survival, graft survival, time to first ARE, causes of graft failure, adverse events and serial growth data from transplant to 60 months were evaluated to address the following issues: Does rhGH treatment prior to transplantation influence patient survival, graft survival or the incidence of ARE following renal transplantation? Does rhGH prior to transplantation influence the incidence of adverse events, especially the development of de novo malignancy following renal transplantation? Does "catch down" growth occur following discontinuation of rhGH at the time of transplantation in patients manifesting accelerated growth in conjunction with rhGH treatment during CRI? Data from the cohort group pf 102 patients were compared with data from 4913 primary transplants from "other NAPRTCS" recipients (the "control" group). Results: There was no significant difference in patient survival, graft survival, incidence of ARE or time to first rejection episode between the cohort and control groups. There were no specific adverse events attributable to prior rhGH treatment. Only 2 patients developed post-transplant lymphoproliferative disease (PTLD) in the cohort group with no other malignancies reported. Both recipients with PTLD were alive with functioning grafts at 7 and 53 months following the diagnosis of PTLD. The mean height Z-scores in the cohort group at baseline and 60 months post transplant were −1.92 and −1.90. The Δ Z-score at 60 months was +0.20. These results were slightly better than those described for the control group (−1.88 and −2.10). Conclusions: Treatment of growth retarded patients with CRI does not adversely effect graft function following renal transplantation. "Catch down" growth does not occur following renal transplantation.