Table 4.
Proposed recommendations for the use of rhGH in children with a renal transplant
| Recombinant human growth hormone therapy | Factors to take into consideration |
|---|---|
| Target population for rhGH therapy | Prepubertal children |
| Pubertal children? | |
| −2 SDS for height | |
| Poor growth velocity? | |
| Growth potential documented by open epiphyses | |
| Correction of other factors contributing to growth failure | |
| Contra-indication | Active malignancy |
| Baseline evaluation | Pubertal stage |
| Anthropometric assessment | |
| Target height | |
| Hip X-ray and bone age | |
| Fundoscopic examination | |
| Serum phosphate, calcium and PTH | |
| Optimal dose of rhGH | 0.05 mg/kg per day (4 IU/m2 per day) |
| Mode of administration | Daily subcutaneous injection |
| Follow-up evaluation | Height, weight, growth velocity every 3 months |
| Close monitoring of graft function in children with a history of acute rejection | |
| Serum calcium, phosphate and PTH every 3 months | |
| Bone age every year according to growth profile | |
| rhGH discontinuation | Achieved height endpoint |
| Closed epiphyses | |
| Slipped femoral epiphyses | |
| Severe hyperparathyroidism | |
| Active malignancy | |
| Documented benign intracranial hypertension | |
| Non compliance |