Prognostic significance of growth hormone in pediatric liver transplantation

R. Kurabekova, O. Silina, O. Tsirulnikova, I. Pashkova, O. Gichkun, G. Olefirenko, S. Y. Oleshkevich, A. Monakhov, O. Shevchenko
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Abstract

Growth hormone (GH) plays a leading role in the regulation of cell and tissue metabolism and growth. Its effects are mediated through the so-called somatomedins, among which the most important is the liver-produced insulinlike growth factor 1 (IGF-1). It has been reported that serum GH levels in liver recipients is related to the clinical transplant outcomes.Objective: to evaluate the prognostic significance of GH in pediatric liver transplantation (LT).Materials and methods. The study enrolled 148 children (61 boys) aged 2 to 60 months (median, 8) with end-stage liver disease resulting from biliary atresia (n = 86), biliary hypoplasia (n = 14), Byler disease (n = 15), Alagille syndrome (n = 12), Caroli syndrome (n = 5), and other liver diseases (n = 16, cryptogenic cirrhosis, fulminant and autoimmune hepatitis, Crigler–Najjar and Budd–Chiari syndromes, alpha-1 antitrypsin deficiency, glycogenosis and hepatoblastoma). All the patients were transplanted with the left lateral segment of the liver from a living related donor. GH concentrations were measured by enzyme immunoassay before, at one month and at one year after transplantation.Results. Median plasma GH levels in children with liver disease were 4.3 [1.6–7.2] ng/mL, significantly higher than in healthy children of the same age at 1.2 [0.3–2.4] ng/mL, p = 0.001, while mean height and body weight were lower than in healthy controls. GH levels decreased significantly after transplantation. At one month and one year later, the levels did not differ from those of healthy children (p = 0.74, p = 0.67, respectively). One month after transplantation, GH concentrations were lower in 1-year survivors than in non-survivors (p = 0.02); the diagnostically significant threshold GH level was 1.8 ng/mL. Prior to LT, plasma GH levels did not differ between 1-year survivors and non-survivors. Children with GH levels below 1.8 ng/mL post-LT were 9 times more likely to survive one year post-transplant than patients with levels above the threshold.Conclusion. GH concentrations in pediatric liver recipients is a positive prognostic indicator of pediatric LT outcomes.
生长激素在小儿肝移植中的预后意义
生长激素(Growth hormone, GH)在调节细胞和组织的代谢和生长中起主导作用。它的作用是通过所谓的生长激素介导的,其中最重要的是肝脏产生的胰岛素样生长因子1 (IGF-1)。据报道,肝受体血清生长激素水平与临床移植结果有关。目的:探讨生长激素对小儿肝移植预后的影响。材料和方法。该研究纳入了148名儿童(61名男孩),年龄在2至60个月(中位数,8名),患有由胆道闭锁(n = 86)、胆道发育不全(n = 14)、Byler病(n = 15)、Alagille综合征(n = 12)、Caroli综合征(n = 5)和其他肝脏疾病(n = 16)、隐源性肝硬化、重型和自身免疫性肝炎、Crigler-Najjar综合征和Budd-Chiari综合征、α -1抗胰蛋白酶缺乏症、糖原症和肝母细胞瘤)引起的终末期肝病。所有患者都移植了来自活体亲属供体的左外侧肝段。采用酶免疫法测定移植前、移植后1个月和移植后1年的生长激素浓度。肝病患儿血浆GH中位数为4.3 [1.6-7.2]ng/mL,显著高于同龄健康儿童的1.2 [0.3-2.4]ng/mL, p = 0.001,而平均身高和体重均低于健康对照组。移植后生长激素水平明显下降。在一个月和一年后,这些水平与健康儿童没有差异(p = 0.74, p = 0.67)。移植后1个月,存活1年的患者生长激素浓度低于未存活患者(p = 0.02);诊断意义阈值GH为1.8 ng/mL。在肝移植之前,1年幸存者和非幸存者的血浆GH水平没有差异。移植后生长激素水平低于1.8 ng/mL的儿童移植后1年生存率是高于该阈值的儿童的9倍。儿童肝受体生长激素浓度是儿童肝移植预后的积极预后指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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