Evaluation of growth in low-body-weight kidney transplant Egyptian children: 25-year experience

Identification of problems associated with kidney transplantation in low-body-weight children is an essential step toward improving graft function and patient survival as well as quality of life. This study comprised 63 renal transplant children weighing 25 kg or less at time of renal transplantation. All children received a living donor renal allotransplant between December 1984 and March 2009. These children were retrospectively evaluated regarding their survival, graft survival as well as physical growth. Our patient and graft survival rates at 1, 5 and 10 years were 98.4%, 96.8% and 96.8%, and 94.9%, 82.6% and 58.4%, respectively. Significant risk factors for growth retardation post renal transplant were identified and included older age at time of transplant (p=0.019), female sex (p=0.010), retarded growth at time of transplant (p=0.011, by univariate analysis, and p=0.028, by multivariate analysis), incidence of chronic rejection (p=0.012), higher steroid cumulative dose (p=0.013) and graft dysfunction (p=0.009, by multivariate analysis). The current final height of low-body-weight transplant Egyptian children has remained suboptimal. The management of growth retardation posttransplant is multifactorial and should start early before transplantation, with optimal care of growth in children with chronic kidney disease. Moreover, expedited transplantation, whenever indicated, and optimization of posttransplant graft function with minimal steroid exposure are essential factors which were shown to be possible using immunosuppression based on tacrolimus plus mycophenolate mofetil, after basiliximab induction.