A longitudinal study of the natural history of growth post-transplantation.
A longitudinal study of the natural history of growth post-transplantation.
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移植后生长自然史的纵向研究。
DOI：
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发表时间：
1996
期刊：
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通讯作者：
E. Sullivan
中科院分区：
文献类型：
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作者：
A. Tejani;L. Cortés;E. Sullivan
我们评估了587例接受功能性肾移植至少54个月的患者，这些患者的基线和连续两年一次的身高测量是可用的。使用标准表将所有身高数据转换为SD评分（SDS）或Z评分。将这些患者的结果与我们之前在移植后2年（N = 300）和3年（N = 412）收集的数据进行比较。三个时间段内研究组的人口统计学相似。第一项研究中的身高不足为-2.41;第二个研究阶段结束时为-2.46，第三个研究阶段结束时为-2.29。第一个研究阶段的儿童身高SDS（delta Z）改善了+0.18，第二个阶段改善了+0.16，第三个研究阶段结束时改善了+0.11。当通过供体来源评价身高SD的改善时，未观察到活体相关和尸体供体移植之间的差异。按种族分析身高SDS显示，在第二和第三个研究阶段，高加索儿童的身高SDS稳定改善0.18，而在第三个研究阶段结束时，非洲裔美国人和西班牙裔儿童的身高SDS实际上有所减缓（P < 0.02）。多因素分析表明，只有初始身高不足和受体年龄是移植后身高改善的独立预测因素。追赶性生长（定义为改善1 SDS）仅见于缺陷最严重的患者或0至1岁的儿童。总体而言，只有47%的2至5奥尔兹出现追赶性生长。对于占总研究队列72%的6岁以上儿童，几乎没有发现追赶性生长。我们的长期研究表明，在移植后的第一年，当肾功能仍然稳定时，大多数6岁以上的儿童不会出现身高加速，有必要采取其他策略来改善这些儿童的生活质量。
We have evaluated 587 patients with a functioning renal allograft for at least 54 months in whom baseline and continuous bi-annual height measurements were available. All height data were converted into SD score (SDS) or Z-score using normative tables. The results obtained in these patients were compared to our previous data collected at two years (N = 300) and three years (N = 412) post-transplantation. The demography of the study groups in the three time periods was similar. The height deficit in the first study was -2.41; it was -2.46 at the end of the second study period and was -2.29 at the end of the third study period. Children in the first study period had an improvement in height SDS (delta Z) of +0.18, of +0.16 in the second period, and of +0.11 at the end of the third study period. When improvement in height SD was evaluated by donor source, no differences were noted between living related and cadaver donor transplants. Analysis of height SDS by race revealed that, whereas for Caucasian children a steady improvement of 0.18 was noted during both second and third study periods, there was actual deceleration of growth for the African-American and Hispanic children at the end of the third study period (P < 0.02). Multivariate analysis showed that only initial height deficit and recipient age were independent predictors of improved height post-transplantation. Catch up growth, defined as an improvement of 1 SDS, was seen only in those with the greatest deficit or in children 0 to 1 year of age. Overall, catch up growth was seen in only 47% of 2 to 5 year olds. For children over the age of six years who form 72% of the total study cohort, little catch up growth was noted. Our long-term studies reveal that in the first years post-transplantation, when renal function is still stable, height acceleration does not occur in most of the children over the age of six years, and alternative strategies are necessary to improve the quality of life of these children.