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Growth After Renal Transplantation in Children

Growth (3–16 cm) has occured in only 6 of 19 renal allograft recipients aged 2 to 18 years, who have survived 6 to 36 months post-transplantation. At the time of transplantation 9 of 19 children were < 10th percentile in height for their chronologic age; 5 were > 10th percentile and 5 were > 50th percentile. Growth has occured in 5 of 6 children < 12 years of age at the time of transplantation and in only 1 of 13 > 12 years at transplantation. Eight of 12 children > 12 years who did not grow after transplantation had fused distal femoral and/or proximal tibial epiphyses at the time of transplantation. The daily dose of prednisone was <15 mg at the time of growth in 5 of the 6 children who grew, whereas, all the children who did not grow were receiving > 15 mg daily. No spectacular (> 4 cm) catch-up growth occured during the first 6 months after transplantation. The child who has survived the longest and has grown 16 cm in 36 months, required < 8 mg of prednisone daily for the past 33 months. One 7 ½-year-old boy grew 4 cm during the first 6 months after transplantation while receiving 10 mg of prednisone daily; chronic rejection occured and no further growth has occurred during the next 18 months. Menstruation has occurred in 4 of 6 adolescent girls 4 to 12 months after transplantation; all had menses prior to transplantation. The lack of growth post-renal homotransplantation is related to the dosage of prednisone used for immuno-suppression, the absence of growth potential at the time of transplantation and the development of chronic rejection.