Early corticosteroid withdrawal is associated with improved adult height in pediatric kidney transplant recipients

Background Catch-up growth after pediatric kidney transplantation (kTx) is usually insufficient to reach normal adult height. We aimed to analyze the effect of pre-transplant recombinant human growth hormone (rhGH) and corticosteroid withdrawal on linear growth in the first year after kidney transplantation and identify factors associated with final height (FH). Methods Patients who underwent kTx between 1996 and 2018 at below 18 years old in five Belgian and Dutch centers were included. We analyzed the differences between height Z-scores at kTx and 1 year post-transplant (Delta height Z-score) in children with and without corticosteroids at 1 year (CS +/CS -) and with and without rhGH treatment before kTx (rhGH +/rhGH -). Univariable and multivariable linear regression analysis was applied to identify factors associated with height Z-score at 1 year post-kTx, Delta height Z-score, and FH Z-score. Results A total of 177 patients were included, with median age 9.3 years at kTx. Median height Z-scores pre-kTx and 1 year later in the CS - /rhGH - , CS +/rhGH - , CS - /rhGH +, and CS +/rhGH + groups were -1.42/ - 0.80, - 0.90/ - 0.62, -1.3 5/ - 1.20, and - 1.30/ - 1.60 (p = 0.001). CS use 1 year post-kTx was the only factor associated with Delta height (p = 0.003) on multivariable analysis. CS use at 1 year was the only variable associated with FH (p = 0.014) in children with pre-transplant height Z-score below -1 (n = 52). Conclusions Increase in height Z-score in the first year post-kTx was highest in the CS - /rhGH - group and lowest in the CS +/rhGH + group. The use of corticosteroids at 1 year post-kTx is associated with catch-up growth and in children with pre-transplant height Z-score below -1 also with final height