Growth and development following paediatric kidney transplantation: Mechanisms, influencing factors, and clinical management.

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.