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Growth hormone found to predict graft function, survival post-liver transplant

Stabilized insulin-like growth factor 1 serum levels after liver transplantation predicted long-term survival post-transplant and was correlated with graft and liver function, according to study findings.

“This study is the first to demonstrate that a prompt recovery of [insulin-like growth factor 1] serum levels is associated with long-term patient survival and shorter hospital stay in [liver transplant] recipients,” the researchers wrote. “This marker was also confirmed to be a reliable index of hepatocellular functional reserve and was able to identify different patterns of recovery between standard and [expanded criteria donor] liver grafts.”

Between April 2010 and May 2011, the researchers assessed IGF-1 plasma levels of 31 patients before liver transplantation and at 30, 90, 180 and 1 year post-transplant. Various donor and recipient characteristics were analyzed and the impact of IGF-1 on survival and correlation with liver testing was investigated by the researchers, according to the study.

Overall, 61.3% of patients (n = 19) had high preoperative IGF-1 plasma levels (mean ± SEM:

6.3 ± 0.9 ng/mL). However, at 15 days post-transplant, an increase in IGF-1 plasma was observed among the patients (102.7 ± 11.7 ng/ml; P < .0001), but then returned to normal, stable levels.

One year after liver transplant (LT), three of 24 surviving patients had pathological growth hormone levels. All patients showed low preoperative IGF-1 levels (mean±SEM: 29.5 ± 2.1 ng/mL).

“The etiology of liver cirrhosis did not influence basal IGF-1 levels, but a significant inverse correlation between the degree of liver dysfunction assessed by the MELD score and IGF-1 values before LT was observed,” according to the researchers.

Starting from the first month after LT, IGF-1 serum levels remained significantly lower in recipients who received a transplant from a donor aged 65 years or older, and this difference remained the same up to 1 year post-transplant.

A correlation analysis showed an inverse correlation between IGF-1 and bilirubin serum levels 15 days post-transplant (P = .0320) and 30 days post-transplant (P = .0368). In addition, a positive correlation between IGF-1 and serum albumin 30 days post-transplant was observed (P = .001) and 90 days post-transplant (P = .003).

Multivariate analysis showed IGF-1 normalization within 15 days post-transplant to be the only prognostic factor associated with an increased 3-year survival (P = .0484).

The researchers concluded: “A larger number of patients is needed to confirm the clinical and prognostic significance of GH/IGF-1 axis recovery in the context of LT. However, on a purely speculative basis, our findings suggest that IGF-1 could represent a new donor-specific qualitative assay, identifying those grafts who are unable to withstand the injuries associated with procurement, cold preservation, and reperfusion and that result in a higher risk of graft failure.”

Disclosures: The researchers report no relevant financial disclosures.