Download Outcome, growth and body composition monitoring in paediatric

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OUTCOME, GROWTH AND BODY COMPOSITION MONITORING IN
PAEDIATRIC RENAL TRANSPLANT RECIPIENTS IN LEEDS OVER THE LAST 5
YEARS
Norton, D, Tyerman, K, Lindley, E, Ahmad, N
Department of Paediatric Nephrology, Leeds Teaching Hospitals NHS Trust
BACKGROUND: The treatment of paediatric renal transplant patients with steroid-free
immunosuppressive approaches has received interest in recent years owing to the propensity of
steroids to stifle growth. Steroids are however still used as part of triple immunosuppressive
regimes in paediatric kidney transplant recipients and their impact on growth beyond the six
months post-transplant mark has not been extensively reported. Steroid medication is also
associated with excessive weight gain. Bioimpedance analysis performed with the Body
Composition Monitor (Fresenius Medical Care, Bad Homburg) allows the relationship between
body composition and steroid use to be examined. The purpose of this study was to assess
whether there is correlation between Cumulative Steroid Dose (CSD) administered posttransplant, and growth, Body Mass Index (BMI) or body composition.
METHODS: Paediatric renal transplant patients who received their graft in Leeds between 1 st
January 2007 and 31st December 2011 were eligible. Exclusion was limited to patients with
permanent pacemakers or implantable cardioverter-defibrillators. Patient notes were audited for
relevant baseline characteristics including but not limited to demographics, cumulative steroid
dose six months post-transplant and growth velocity at six-monthly intervals. Body
Composition Monitoring (BCM) was performed on a smaller cohort of children during a routine
clinic appointment.
RESULTS: Thirty-three patients (14 female and 19 male) were included in the study, (mean
age at transplant 8.25 years) nine of whom underwent BCM. The notes of all thirty-three
patients were audited. The most common single aetiology of renal failure was renal dysplasia (n
= 7, 21.2%). Mean graft Cold Ischaemia Time (CIT) was 11.7 hours. Mean estimated
Glomerular Filtration Rate was 68.3 ml/min/1.73m2 at 6 months and 64.7 ml/min/1.73m2 at 12
months. Mean CSD was 1.8g/m2. Measured via the Pearson correlation coefficient (r), the
correlation between CSD and growth velocity at 6 monthly intervals post-transplant for five
years was varied and negligible (-0.324 ≤ r ≥ 0.215). The correlation between CSD and sixmonthly BMI was also varied (-0.503 ≤ r ≥ 0.0577) with moderate negative correlation present
toward the end of the 5 year period. CSD was moderately negatively correlated with percentage
adipose tissue measured by BCM (r = -0.490). The mean difference in growth velocity 1 year
prior to and 1 year post-transplant was 1.11cm/year. This difference was not associated with
CSD.
COMMENTS: It was surprising to see no real association between CSD and growth velocity.
The same is true for CSD, BMI and percentage adipose tissue. This could possibly be explained
by an improved focus on post-transplant nutrition and vigilant monitoring of growth. The
number of patients on whom BCM could be performed was however small, making the data
more qualitative in terms of future use. In order to address the limitations of this study, a future
iteration could be multi-centre and prospective. Serial BCM measurements could be performed
in place of a cross-sectional approach and stratification of the patients by pubertal status should
also be considered to examine how CSD affects the growth of children who are at different
pubertal stages.