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Background <p>We investigated factors associated with post-transplant growth in pediatric kidney transplant (KTx) recipients with a focus on plasma bicarbonate (HCO3<sup>−</sup>) and estimated the effect of alkali treatment on growth.</p> Methods <p>In this study of the CERTAIN Registry, data were collected up to 5&#xa0;years post-transplant. Generalized Additive Mixed Models were applied to assess the association between post-transplant growth and covariates. A trial-emulation analysis was performed to estimate the causal effect of alkali supplementation on growth.</p> Results <p>We report on 2147 primary KTx recipients with a median age at KTx of 10.2 (IQR 5.1;14.3) years. No statistically significant association was found between growth and HCO3<sup>−</sup> (<i>p</i> = 0.21), but the shape of the estimated conditional association showed a decreasing estimated growth with increasing HCO3<sup>−</sup>. Glucocorticoid treatment and allograft rejection showed an inverse association with growth. Living donor KTx, glomerulopathy, recombinant growth hormone use, low height <i>z</i>-score at KTx, younger age, and higher eGFR were positively associated with growth. The trial-emulation analysis included patients at 30&#xa0;days and 3, 6, and 9&#xa0;months post-transplant with HCO3<sup>−</sup>  &lt; 22&#xa0;mmol/L and no prior alkaline treatment. Alkaline treatment was initiated in 194, 93, 47, and 25 patients, respectively. After adjustment for confounders, there was no significant difference in growth at 1-year post-transplant in treated and untreated patients.</p> Conclusions <p>We found no association between HCO3<sup>−</sup> and growth nor evidence of improved growth after treatment of metabolic acidosis. Living donor KTx was positively associated with post-transplant growth, while there was an inverse association with allograft rejection.</p> Graphical Abstract <p></p>

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Factors associated with statural growth in pediatric kidney transplant recipients with focus on metabolic acidosis

  • 期刊论文

  • 发表日期：

    2025年1月27日

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  • Agnieszka Prytuła,
  • Dries Reynders,
  • Els Goetghebeur,
  • Kai Krupka,
  • Justine Bacchetta,
  • Nele Kanzelmeyer,
  • Isabella Guzzo,
  • Raffaella Labbadia,
  • Elisa Benetti,
  • Mohan Shenoy,
  • Anne-Laure Sellier-Leclerc,
  • Jun Oh,
  • Mieczysław Litwin,
  • Jacek Rubik,
  • Atif Awan,
  • Ilmay Bilge,
  • Lutz T. Weber,
  • Dominik Müller,
  • Thomas Simon,
  • Lars Pape,
  • Burkhard Tönshoff,
  • Demet Alaygut,
  • Gema Ariceta,
  • Martin Bald,
  • Nina Battelino,
  • Ortraud Beringer,
  • Laszlo Berta,
  • Antonia Bouts,
  • Olivia Boyer,
  • Salim Caliskan,
  • Ali Duzova,
  • Henry Fehrenbach,
  • Wesley Hayes,
  • Kristina Heindl-Rusai,
  • Julien Hogan,
  • Ulrike John-Kroegel,
  • Jon Jin Kim,
  • Michael Kaabak,
  • Günter Klaus,
  • Martin Konrad,
  • Stephen Marks,
  • Hulya Nalcacioglu,
  • Aytül Noyan,
  • Ozan Ozkaya,
  • Martin Pohl,
  • Michael Pohl,
  • Licia Peruzzi,
  • Nikoleta Printza,
  • Alexandr Rumyantsev,
  • Katja Sauerstein,
  • Oguz Söylemezoglu,
  • Gesa Schalk,
  • Hagen Staude,
  • Sara Testa,
  • Marcus Weitz,
  • Fatos Yalcinkaya,
  • Jakub Zieg

摘要

Background

We investigated factors associated with post-transplant growth in pediatric kidney transplant (KTx) recipients with a focus on plasma bicarbonate (HCO3−) and estimated the effect of alkali treatment on growth.

Methods

In this study of the CERTAIN Registry, data were collected up to 5 years post-transplant. Generalized Additive Mixed Models were applied to assess the association between post-transplant growth and covariates. A trial-emulation analysis was performed to estimate the causal effect of alkali supplementation on growth.

Results

We report on 2147 primary KTx recipients with a median age at KTx of 10.2 (IQR 5.1;14.3) years. No statistically significant association was found between growth and HCO3− (p = 0.21), but the shape of the estimated conditional association showed a decreasing estimated growth with increasing HCO3−. Glucocorticoid treatment and allograft rejection showed an inverse association with growth. Living donor KTx, glomerulopathy, recombinant growth hormone use, low height z-score at KTx, younger age, and higher eGFR were positively associated with growth. The trial-emulation analysis included patients at 30 days and 3, 6, and 9 months post-transplant with HCO3−  < 22 mmol/L and no prior alkaline treatment. Alkaline treatment was initiated in 194, 93, 47, and 25 patients, respectively. After adjustment for confounders, there was no significant difference in growth at 1-year post-transplant in treated and untreated patients.

Conclusions

We found no association between HCO3− and growth nor evidence of improved growth after treatment of metabolic acidosis. Living donor KTx was positively associated with post-transplant growth, while there was an inverse association with allograft rejection.

Graphical Abstract