TREATMENT OF GROWTH FAILURE IN CHILDREN AFTER RENAL-TRANSPLANTATION

Growth failure continues to be a problem in the management of children with renal failure. Children have improved growth after successful renal transplantation, but seldom have 'catch-up'' growth, or normal adult height. In this study we report the findings of an open label pilot study to determine the safety and efficacy of the use of recombinant human growth hormone (rhGH) in children with growth failure after successful renal transplantation. Eleven children completing at least 1 year of treatment had a mean age of 11.5 years (+/-3.3) and mean bone age of 8.4 years (+/-2.4), and were significantly growth-retarded (mean standard deviation score of -3.18 [+1.1]). After receiving rhGH (0.05 mg/kg) subcutaneously each day the height velocity increased from 5.2 cm/year to 8.4 cm/year (P=0.003), and the standard deviation score improved from -3.18 to -2.23 (P=0.004). Treatment was associated with advancement in Tanner stage from 1 to 2.8 (P=0.004), increased bone age from 8.4 years to 10.9 years (P=0.0002), and although it was not at the point of statistical significance, moderate decrease in creatinine clearance from 75 ml/1.73m2/min to 60 ml/1.73m2/min (P=0.1). The advancement in Tanner stage and bone age was not out of proportion to the advancement in height age. These data suggest that children with functioning renal allografts have improved growth with supraphysiologic doses of rhGH.