Growth hormone improves growth in pediatric renal transplant recipients-a systemic review and meta-analysis of randomized controlled trials

Growth hormone had been applied to treat pediatric renal allograft recipients with growth retardation. In this systemic review and meta-analysis, we assess the efficiency and safety of growth hormone use in post-renal transplant children. A literature search revealed five prospective randomized controlled trials assessing this therapy, with a total of 401 patients. The outcomes, including the baseline height standard deviation score (HSDS), HSDS after a 1-year therapy, delta height standard deviation score (a-(HSDS)-H-3), allograft rejection rates and changes in the glomerular filtration rates (GFR) were analyzed. Pooled data of the five studies showed that 1 year after the randomized controlled trials, the experimental group receiving growth hormone had a significantly higher growth velocity than the control group, with a mean HSDS difference of 0.68 [95 % confidence interval (CI) 0.25-1.11, P = 0.002] between the two groups. The mean difference in the a-(HSDS)-H-3 between the treated and control group was 0.52 (95 % CI 0.37-0.68, P < 0.00001). The rejection episode rates were 35/205 and 19/185, respectively (number of patients with rejection/ total number of patients) (risk ratio 1.56, 95 % CI 0.97-2.53, P = 0.07), and the mean difference in the a-(3)GFR was 3.27 ml/min per 1.73 m(2) (95 % CI -3.54-10.09, P = 0.35), which was not statistically significant. Based on these studies, we suggest that the application of growth hormone is an effective treatment to promote the growth velocity of children after kidney transplantation. However, the safety of this treatment needs further evaluation.