We are aware that neither in the USA nor in Europe is GH approved for treatment of growth failure after transplantation. In Germany, insurance companies usually pay for the treatment if the patient has a reduced glomerular filtration rate (GFR) of 50 % of normal. The American Association of Clinical Endocrinology did not recommend the use of GH in transplanted patients outside research studies. In contrast,The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines do notexclude small transplanted patients from treatment if renal
function is impaired .