Abstract
BackgroundThe reduction of insulin-like growth factor 1 (IGF-1) plasma levels is associated with the degree of liver dysfunction and mortality in cirrhotic patients. However, little research is available on the recovery of the IGF-1 level and its prognostic role after liver transplantation (LT).MethodsFrom April 2010 to May 2011, 31 patients were prospectively enrolled (25/6 M/F; mean age±SEM: 55.2±1.4 years), and IGF-1 serum levels were assessed preoperatively and at 15, 30, 90, 180 and 365 days after transplantation. The influence of the donor and recipient characteristics (age, use of extended criteria donor grafts, D-MELD and incidence of early allograft dysfunction) on hormonal concentration was analyzed. The prognostic role of IGF-1 level on patient survival and its correlation with routine liver function tests were also investigated.ResultsAll patients showed low preoperative IGF-1 levels (mean±SEM: 29.5±2.1), and on postoperative day 15, a significant increase in the IGF-1 plasma level was observed (102.7±11.7 ng/ml; p<0.0001). During the first year after LT, the IGF-1 concentration remained significantly lower in recipients transplanted with older donors (>65 years) or extended criteria donor grafts. An inverse correlation between IGF-1 and bilirubin serum levels at day 15 (r = -0.3924, p = 0.0320) and 30 (r = -0.3894, p = 0.0368) was found. After multivariate analysis, early (within 15 days) IGF-1 normalization [Exp(b) = 3.913; p = 0.0484] was the only prognostic factor associated with an increased 3-year survival rate.ConclusionIGF-1 postoperative levels are correlated with the graft’s quality and reflect liver function. Early IGF-1 recovery is associated with a higher 3-year survival rate after LT.
Highlights
The liver plays a pivotal role in the homeostasis of the growth hormone (GH)/insulin growth factor-1 (IGF-1) axis and secretes more than 90% of circulating IGF-1 and mediates the effects of GH on cellular cycle regulation and metabolism[1, 2]
During the first year after liver transplantation (LT), the IGF-1 concentration remained significantly lower in recipients transplanted with older donors (>65 years) or extended criteria donor grafts
In the case of liver cirrhosis, the impaired synthetic capacity of the hepatocellular mass, combined with the reduction of GH liver receptors lead to a decrease in IGF-1 and insulin growth factor 1 binding proteins (IGFBPs) serum levels[5,6,7]
Summary
The liver plays a pivotal role in the homeostasis of the growth hormone (GH)/insulin growth factor-1 (IGF-1) axis and secretes more than 90% of circulating IGF-1 and mediates the effects of GH on cellular cycle regulation and metabolism[1, 2]. Studies on pediatric and adult patients have demonstrated a dramatic recovery of the GH/ IGF-1 axis after liver transplantation (LT), which suggests that IGF-1 serum levels can be useful in monitoring the graft’s function in the postoperative period[13,14,15,16]. Bassanello and colleagues observed an increase in IGF-1 serum levels starting 30 minutes after reperfusion of the graft and a normalization of hormonal values between one week and 1 month after surgery, accompanied with a complete hepatic recovery of the 15 recipients included in the study[17]. The reduction of insulin-like growth factor 1 (IGF-1) plasma levels is associated with the degree of liver dysfunction and mortality in cirrhotic patients. Little research is available on the recovery of the IGF-1 level and its prognostic role after liver transplantation (LT)
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