S. Sarna et al., GROWTH DELAY AFTER LIVER-TRANSPLANTATION IN CHILDHOOD - STUDIES OF UNDERLYING MECHANISMS, Pediatric research, 38(3), 1995, pp. 366-372
After liver transplantation in children, growth is often impaired, but
the underlying mechanisms are unknown. Glucocorticoids used for immun
osuppression are believed to be partly responsible. After renal transp
lantation in children, reduced growth hormone (GH) secretion and incre
ased serum insulin-like growth factor-binding protein-3 (IGFBP-3) leve
ls have been reported. We attempted to find endocrine factors predicti
ng growth in 18 prepubertal children followed for more than 1 y (mean
2.4 y) after liver transplantation. Spontaneous and stimulated GH secr
etion, serum IGF-I, IGFBP-3 concentrations, and endogenous cortisol pr
oduction were measured. GH secretion was reduced in only two patients.
Serum IGF-I concentration was normal, but serum IGFBP-3 was elevated
or 1 SD above the mean for age in 62% of the patients. Endogenous cort
isol production was reduced in most patients during the first year and
improved later in only a few. Growth velocity after transplantation d
id not correlate with GH secretion, serum IGF-I or IGFBP-3 concentrati
on, or with methylprednisolone dose, but correlated positively with se
rum basal (r(s) = 0,44, p < 0.05) and stimulated (r(s) = 0.53, p < 0.0
05) cortisol concentration. In conclusion, after liver transplantation
1) the normal pulsatile character of nocturnal GH secretion is sustai
ned, and the GH response to stimulation is reduced in only a few patie
nts; 2) serum IGF-I concentrations are normal; 3) serum IGFBP-3 concen
trations are elevated or in the upper part of the normal range in most
patients; and 4) endogenous cortisol production is reduced in most pa
tients and correlates positively with growth velocity.