003 1-399819413603-0323$03.0010 PEDIATRIC RESEARCH Copyright d 1994 International Pediatric Research Foundation. Inc. Final Height and Its Predictive Factors after Renal Transplantation in Childhood A. C. S. HOKKEN-KOELEGA, M. A. E. VAN ZAAL, W. VAN BERGEN, M. A. J. DE RIDDER, T. STIJNEN, E. D. WOLFF, R. C. J. W. VE JONG, R. A. DONCKERWOLCKE, S. M. P. F. DE MUINCK KEIZER-SCHRAMA, AND S. L. S. DROP Department of Pediatrics, Division of Endocrinology and Nephrology, Sophia Childret~ '.F HospitallErasmus University, Rotterdam [A. C. S. H. -K., M.A. E. I,. Z., W. V. B., E. D. W . , S. M. P. F. d.M. K. -S., S. L. S. D. 1; Radboud Hospital, Nijmegen [R.C. J. W. d. J. 1; Wili~elmina Children's Hospital, Utrecht [R.A.D.];and Department of Epidemiology and Biostatistics, Erasmus University Rotterdam, The NetherIand.7 1M.A. J.d. R., T. S. 1 A retrospective study is reported assessing final height (FH) and its predictive factors in 52 patients (31 male, 21 female) who underwent renal transplantation (RTx) before the age of 15 y. They received prednisone daily or on alternate days as well as azathioprine. The study period covered 20 y. FH remained below the third height percen- tile [height standard deviation score for chronologic age (hSDS,,) < -1.881 for most of these patients (77% males, 71% females). Median (range) FH was 165.0 (143.0-176.8) cm in males and 153.0 (135.0-168.4) cm in females. Median difference between FH and target height was 15.0 and 15.4 cm for males and females, respectively. For both sexes, the median hSDS,, was already below - 1.88 at the start of the first hemodialysis, after which it decreased significantly until the first RTx. After RTx, there was no significant improvement of hSDS,,. The predictive factors for FH were determined by evaluating various factors simultane- ously in a multiple regression analysis. This analysis pro- vided a regression equation for predicting FH. A higher hSDS,, at the time of the first RTx and alternate-day versus daily prednisone therapy both had a significantly positive influence on FH, whereas a longer duration of reduced GFR ( 4 0 mLlminl1.73 m') had a significantly negative effect on FH. Other factors such as age or bone age at first RTx, primary renal disease, duration of initial dialysis, repeat RTx, and the cumulative dose of predni- sone did not influence FH significantly. In conclusion, 71-77% of patients that received their first renal transplant before the age of 15 ended up with severely short adult stature. Optimization of the hSDS,., at first RTx appears very important. Long-term administration of prcdnisone on alternate days would then result in optimal FH, particularly if the GFR remains above 50 mL/min/1.73 m2. (Pediatr Res 36: 323-328, 1994) Abbreviations FH, final height RTx, renal transplantation hSDS,,, height standard deviation score for chronologic age HD, hemodialysis AD, alternate-day Growth failure is a common and serious consequence of chronic renal failure in childhood. The majority of these children now survive thanks to advances in hemo- dialysis and RTx, but successful transplantation rarely results in full growth rehabilitation. Some children show an appreciable improvement in growth after RTx, but the initially increased growth rate may not be sustained dur- ing the ensuing years of immunosuppressive drug admin- istration (1). Van Diemen-Steenvoorde et al. (2) reported that the F H of one third of patients who underwent RTx Received Octoher 21. 1993: accepted Fehruary 4, 1994. Correspondence and reprint requests: A. C. S. Hokken-Koelega, Department of Pediatrics, Division of Endocrinology. Sophia Children's Hospital. Dr. Mole- waterplein 60. 3015 GJ Rotterdam, The Netherlands. Supported by Novo Nordisk, Denmark. before a bone age of 16 y in boys and 14 y in girls remained more than 2 SD score below the mean. The psychosocial consequences of short stature are profound in both children and adults. Recent studies have convinc- ingly shown that recombinant hGH therapy will acceler- ate growth significantly both before (3, 4) and after RTx (5, 6). For a true evaluation of this therapy, it is essential to assess FH and pinpoint its predictive factors in pa- tients not so treated. We carried out a retrospective analysis of patients who received their first RTx before the age of 15 in the Netherlands during the past 20 y. We evaluated their height at the start of the first HD, at the first RTx, and at attainment of FH. In addition, we assessed the impact of several factors on FH.