Effect of childhood kidney transplantation on puberty

ObjectiveTo evaluate sexual and linear growth in kidney transplant (KTX) children receiving cyclosporine A, low-dose prednisolone and azathioprine.Study DesignProspective case-control study.SettingUniversity-affiliated urology and nephrology center, obstetric and gynecology departments.Patient(s)Eighteen girls and 21 boys with successful KTX before the age of 16 years. Controls were healthy and age matched (200 girls and 171 boys).Intervention(s)Assessment of sexual maturation by Tanner staging and linear growth by height standard deviation score (HSDS) and height increment (HI).Main Outcome Measure(s)Pubertal age in KTX vs. control, ratios of KTX with normal and retarded sexual maturation and linear growth.Result(s)Puberty in KTX children was significantly delayed compared with controls. Delayed sexual maturation was found in 22.2% of girls and 19.1% of boys, and poor HSDS was found in 38.9% of girls and 33.3% of boys. Improvement in HSDS was significantly lower in girls compared with boys. Improvement in HSDS did not significantly differ in prepubertal vs. pubertal children. Prepubertal HI was significantly higher than pubertal HI in boys, but not in girls. Significant negative correlation was found between HI, duration of immunosuppression, and serum creatinine level.Conclusion(s)KTX children receiving cyclosporine A, low-dose prednisolone, and azathioprine showed acceptable sexual and physical maturation in a majority of cases. Impaired sexual and linear growth after receiving KTX is related to poor graft function, post-KTX interval, and gender.