C. Pichard et al., Treatment of cachexia with recombinant growth hormone in a patient before lung transplantation: A case report, CRIT CARE M, 27(8), 1999, pp. 1639-1642
Objectives: To describe the effects of recombinant human growth hormone (rh
GH) in a severely malnourished patient before lung transplantation.
Design: Case study.
Setting: Intensive care unit.
Patients: A 38-yr-old severely malnourished (body mass index, 15.1 kg/m(2))
woman (receiving prednisone) with bronchiolitis obliterans evolving during
10 yrs presented with end-stage lung disease and required continuous nonin
vasive mechanical ventilation.
Interventions: Two courses of 35 days of 16 IU/day (0.42 IU/kg/day) rhGH ad
ministered subcutaneously, with an interruption of 5 wks between the two co
urses of rhGH.
Measurements and Main Results: Weight gain of 14.7% and 12.8% fat-free mass
, as measured by 50-kHz bioelectrical impedance analysis, during treatment
during a 3.5-month period. Nitrogen excretion decreased from 23.7 g/day bef
ore treatment to 8.0 g/day while receiving rhGH. Improvement of pulmonary f
unction was also noted and allowed discharge of the patient from the hospit
al after the second course of rhGH. She underwent successful lung transplan
tation 2 months later and reached 48.8 kg of body weight 6 months later.
Conclusions: rhGH treatment is a possible strategy that could be used with
malnourished patients who are awaiting lung transplantation to improve the
nutritional status and respiratory muscle function to prevent recurring res
piratory infection and postoperative complications favored by malnutrition
and possibly to decrease the length of hospital stay.