Wang YY, Hang G, Wen Q, Guo YP, Long C, Chen B. Growth and development following paediatric kidney transplantation: Mechanisms, influencing factors, and clinical management. World J Transplant 2026; 16(3): 120986 [DOI: 10.5500/wjt.120986]
Corresponding Author of This Article
Bo Chen, Department of Urinary Surgery, Tongliao People’s Hospital, No. 668 Horqin Street, Horqin District, Tongliao 028000, Inner Mongolia Autonomous Region, China. chenmuxin@126.com
Research Domain of This Article
Transplantation
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review-article
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Wang YY, Hang G, Wen Q, Guo YP, Long C, Chen B. Growth and development following paediatric kidney transplantation: Mechanisms, influencing factors, and clinical management. World J Transplant 2026; 16(3): 120986 [DOI: 10.5500/wjt.120986]
World J Transplant. Sep 18, 2026; 16(3): 120986 Published online Sep 18, 2026. doi: 10.5500/wjt.120986
Growth and development following paediatric kidney transplantation: Mechanisms, influencing factors, and clinical management
Yu-Yang Wang, Gai Hang, Quan Wen, Yun-Peng Guo, Chen Long, Bo Chen
Yu-Yang Wang, Yun-Peng Guo, Tongliao Clinical Medical College, Inner Mongolia Medical University, Tongliao 028000, Inner Mongolia Autonomous Region, China
Gai Hang, Quan Wen, Department of Urinary Surgery, Tongliao City Hospital, Tongliao 028000, Inner Mongolia Autonomous Region, China
Chen Long, Department of Surgery, Inner Mongolia Medical University, Tongliao 028000, Inner Mongolia Autonomous Region, China
Bo Chen, Department of Urinary Surgery, Tongliao People’s Hospital, Tongliao 028000, Inner Mongolia Autonomous Region, China
Author contributions: Wang YY and Hang G designed the review; Wen Q and Guo YP performed the literature search and drafted the manuscript; Long C and Chen B revised the manuscript critically and approved the final version.
AI contribution statement: ChatGPT (OpenAI, web version) was used solely for English language polishing and grammar correction of the authors’ writting. It was not used for scientific content generation, study design, data analysis, result interpretation, or image creation.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Bo Chen, Department of Urinary Surgery, Tongliao People’s Hospital, No. 668 Horqin Street, Horqin District, Tongliao 028000, Inner Mongolia Autonomous Region, China. chenmuxin@126.com
Received: March 13, 2026 Revised: May 20, 2026 Accepted: August 10, 2026 Published online: September 18, 2026 Processing time: 170 Days and 9.4 Hours
Abstract
Paediatric kidney transplantation substantially improves survival and quality of life in children with end-stage kidney disease. However, impaired linear growth and broader developmental challenges remain common after transplantation. This article provides an evidence-based narrative review of the mechanisms, clinical determinants, monitoring strategies, and management options for post-transplant growth and development in paediatric kidney recipients, with particular emphasis on the growth hormone (GH)-insulin-like growth factor 1 axis, graft function, immunosuppression, nutrition, GH therapy, and long-term follow-up. Current evidence indicates that post-transplant growth is influenced by age at transplantation, pretransplant growth status, graft function, cumulative corticosteroid exposure, nutritional and metabolic status, and the selective use of recombinant human GH. Younger age at transplantation and steroid-sparing strategies are consistently associated with better height outcomes, whereas chronic graft dysfunction, persistent inflammation, and metabolic complications may attenuate catch-up growth. Emerging biomarkers and precision-medicine tools are promising, but most remain insufficiently validated for routine growth-focused decision-making. Optimising growth after paediatric kidney transplantation requires early transplantation when feasible, preservation of graft function, careful balancing of rejection prevention against growth toxicity, multidisciplinary nutritional and endocrine support, and structured long-term follow-up. The evidence base is expanding, but high-quality multicentre longitudinal studies are still needed.
Core Tip: Paediatric kidney transplantation markedly improves survival in children with end-stage kidney disease, yet post-transplant growth and developmental impairment remain a major challenge. This review highlights the multifactorial mechanisms underlying poor growth after paediatric kidney transplantation, including immunosuppressive exposure, incomplete renal recovery, nutritional deficits, and transplant-related complications. It further summarises emerging predictive models and personalised interventions, emphasising early transplantation, steroid-sparing or optimised immunosuppressive strategies, and careful use of growth hormone as key approaches to improve long-term growth and developmental outcomes.
