Optimizing growth in pediatric renal transplant recipients: An update

Abstract

Growth retardation is a significant complication observed in pediatric renal transplant recipients, originating from a multifactorial etiology. Factors contributing to growth impairment encompass pre-transplant conditions such as primary kidney disease, malnutrition, quality of care, growth deficits at the time of transplantation, dialysis adequacy, and the use of recombinant human growth hormone. Additionally, elements related to the renal transplant itself, such as living donors, corticosteroid usage, and graft functioning, further compound the challenge. Although renal transplantation is the preferred renal replacement therapy, its impact on achieving final height and normal growth in children remains uncertain. The consequences of growth delay extend beyond the physiological realm, negatively influencing the quality of life and social conditions of pediatric renal transplant recipients, and ultimately affecting their educational and employment outcomes. Despite advancements in graft survival rates, growth retardation remains a formidable clinical concern among children undergoing renal transplantation. Major risk factors for delayed final adult height include young age at transplantation, pre-existing short stature, and the use of specific immunosuppressive drugs, particularly steroids. Effective management of growth retardation necessitates early intervention, commencing even before transplantation. Strategies involving the administration of recombinant growth hormone both pre- and post-transplant, along with protocols aimed at minimizing steroid usage, are important for achieving catch-up growth. This review provides a comprehensive outline of the multifaceted nature of growth retardation in pediatric renal transplant recipients, emphasizing the importance of early and targeted interventions to mitigate its impact on the long-term well-being of these children from birth to adolescence.

Keywords: Growth; Pediatric; Chronic kidney disease; Renal transplant recipients; Recombinant human growth hormone

Core Tip: Growth retardation is a notable challenge among pediatric kidney transplant recipients. Key risk factors for delayed final adult height include early age at transplantation, pre-existing short stature due to chronic kidney disease and dialysis, and the use of certain immunosuppressive drugs, particularly steroids. To effectively manage growth retardation, early intervention is crucial, ideally beginning before transplantation. Important strategies include administering recombinant growth hormone both before and after the transplant, optimizing nutrition, and employing protocols designed to minimize steroid use. These approaches offer the best chances for achieving catch-up growth in renal transplant recipients.