Somatic growth in infant heart transplant recipients.

UNLABELLED: Infant heart transplantation is now entering its second decade of clinical experience. To understand better issues relating to somatic growth, this retrospective study will describe growth patterns in a group of infant heart transplant recipients. Early growth: growth velocity from birth to transplantation in 77 infants transplanted before 6 months of age was compared with growth velocity from transplant to 3 months. Growth from 3 to 6 months and from 6 to 12 months after transplantation is described. Growth velocities (mean +/- SD) for weight (g/d) and length (cm/yr) for these 4 time periods respectively were: 7+/-14 and 27+/-22, 32+/-9 and 35+/-14, 17+/-7 and 24+/-10, 12+/-6 and 17+/-8. Growth velocities for both weight (p<0.01) and length (p = 0.04) were significantly improved in the first 3 months after transplantation. Late growth: Growth beyond 5 yr post-transplantation was described in a group of 51 infants transplanted in the first year of life and who survived at least 5 yr (median 6.8 yr, range 5.0 to 10.9). Most recent growth parameters (z-score; mean +/- SD) were: weight -0.55+/-1.2, height -0.48+/-0.97 and weight for height -0.16+/-0.96. Factors (with significant p-values) evaluated for their possible influence on late height (<5th percentile vs. > or =5th percentile) were: age at transplant, hospital days from transplant to discharge, hospital days 1st year after transplantation (p = 0.019), hospital days after 1st year, rejection episodes 1st year, rejection episodes 1-5 yr (p = 0.02) mid-parental height (p = 0.008) and isotopic glomerular filtration rate (p = 0.055).
CONCLUSION: Growth while awaiting infant heart transplantation is poor, but adequate catch-up growth does occur. Beyond 5 yr most (88%) infant heart transplant recipients have weight and height in the normal range. Early illness, late rejection and genetic growth potential may play the largest role in later height attainment.