Blood levels of insulin like growth factor-1 (IGF-1) and growth hormone associate with liver function and 6 month survival after pediatric liver transplantation
Sergey Gautier1,2, Rivada Kurabekova1, Olga Tsiroulnikova1,2, Irina Pashkova1, Olga Gichkun1,2, Natalia Mozheiko1, Artem Monakhov1,2, Olga Shevchenko1,2.
1V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs , Moscow, Russian Federation; 2I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
Introduction: System of growth hormone/insulin like growth factor-1 (IGF-1) is an important chain of hormonal regulation of liver function and can have clinical significance at liver transplantation (LT) for graft function and survival prognosis.
Aim: Evaluation of relationship between growth hormone and IGF-1 blood levels and clinical parameters of liver function and short term survival at LT in children.
Materials and Methods: 143 children aged from 3 to 73 months with end stage liver disease caused by biliary atresia (BA) and hypoplasia (90 pts), Alagille syndrome (9 pts), Byler’s (13 pts) and Caroli (8 pts) diseases, and “other” rare non-cholestatic diseases (23 pts) including cryptogenic liver cirrhosis, Budd-Chiari syndrome, alpha-1 antitrypsin deficiency, autoimmune hepatitis, fulminate hepatitis, Crigler-Najjar syndrome and glycogenosis were involved in the study. They underwent living donor liver transplantation of the left lateral sector. Concentration of growth hormone and IGF-1 in blood plasma was measured by ELISA.
Results: Growth hormone concentration was significantly higher and IGF-1 - lower in children with liver diseases than in healthy children (р<0.01). Before LT growth hormone concentration in blood directly correlated with liver fibrosis severity (r=0.47, р=0.02). At cirrhosis (F4) its level was higher than at lower fibrosis grades (F1-F3): 4.7 (2.1-7.2) и 2.1 (1.2-3.3) ng/ml, resp., p=0.02. IGF-1 level was related with liver disease etiology (r=0.30, р=0.004): at BA and other cholestatic diseases the level was lower than at non-cholestatic etiologies: 4.7 (0.0-23.4) и 42.3 (9.0-55.0) ng/ml, resp., p=0.03. LT leads to normalization of IGF-1 and growth hormone blood levels. A month after LT growth hormone concentration correlated with 6 month survival (r=0.36, р=0.01): its level was lower in recipients survived 6 months than in those with lethal outcome: 1.3 (0.5-1.9) и 2.9 (1.6-12.4) ng/ml, resp., p=0.02.
Conclusion: Before LT growth hormone blood level in pediatric liver recipients correlates with liver fibrosis severity and IGF-1 level - with liver disease etiology. After LT growth hormone concentration associates with the recipients short term survival.
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