Francesco Antonio Ciarleglio

Growth hormone/insulin-like growth factor 1 axis recovery after liver transplantation: A preliminary prospective study

Many studies on cirrhotic patients have shown that insulin‐like growth factor 1 (IGF‐1) plasma levels are related to the severity of liver dysfunction. This result suggests that IGF‐1 is probably useful for monitoring liver function in the perioperative course of orthotopic liver transplantation (OLT). Growth hormone (GH), IGF‐1 plasma levels, and routine liver function tests were measured in 15 adult cirrhotic patients undergoing OLT. Measurements were made at the beginning of the operation; during OLT; 24 hours after reperfusion; and in the morning on days 7, 30, and 90. Twenty age‐matched healthy volunteers with normal liver function served as controls. The study group had significantly higher GH levels and lower IGF‐1 levels in the preoperative period compared with the controls. All patients achieved a complete functional hepatic recovery 1 month after OLT, although in 6 of them, the graft had an initial poor function (Group‐IPF). GH and IGF‐1 levels achieved near normal range within 1 week after OLT, and they had no significant correlations with other routine biochemistry tests in this period. IGF‐1 levels in Group‐IPF rose more slowly than in the group with a normal recovery of graft function. Surprisingly, 24 hours after reperfusion, IGF‐1 levels were higher in Group‐IPF than in the group with normal graft function. In conclusion, the severe GH/IGF‐1 axis impairment found in patients with end‐stage cirrhosis reverted very rapidly in the first days after successful OLT. Such a quick, postoperative modulation of IGF‐1 plasma level by the graft suggests that this hormone has the potential to become one of the early indicators of post‐OLT liver function recovery. (Liver Transpl 2004;10:692–698.)

Syngeneic living-donor liver transplantation for hemangioendothelioma: a clinical model for studying liver regeneration.

A 22‐year‐old Caucasian patient underwent living‐donor liver transplantation (LDLT) for hepatic hemangioendothelioma in a healthy liver. The organ donor was his monozygotic twin brother. Surgery was uneventful in both donor and recipient, who received the same postoperative treatment (i.e. no immunosuppression for the recipient). Although both donor and recipient achieved a full liver function recovery, the volume of the recipients graft increased much more than the donors residual liver in the first postoperative month (1.6‐fold vs. 1.2‐fold). This different growth rate correlated with growth hormone (GH)/insulin growth factor (IGF) axis dynamics: the donor had significantly lower insulin‐like growth factor 1 (IGF‐1), insulin‐like growth factor 2 (IGF‐2) and insulin‐like growth factor binding protein 3 (IGFBP‐3) values than the recipient on postoperative days (POD) 3–30, although they had similar GH values. Other potential regenerative factors, e.g. tumor necrosis α, interleukin 6 (IL‐6), insulin and C peptide did not correlate with liver regeneration rate. The particular endocrine picture of the graft may be explained by a modified GH‐hepatocyte interaction due to cold ischemia during preservation resulting in a higher IGF production. Whether this is a potential molecular tool by means of which transplanted partial livers promote their regeneration remains to be seen in a larger number of patients.