Nicolini Daniele, Mocchegiani Federico, Palmonella Gioia, Coletta Martina, Brugia Marina, Montalti Roberto, Fava Giammarco, Taccaliti Augusto, Risaliti Andrea, Vivarelli Marco
Division of Hepatobiliary and Transplant Surgery, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, Ancona, Italy.
Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
PLoS One. 2015 Jul 17;10(7):e0133153. doi: 10.1371/journal.pone.0133153. eCollection 2015.
The reduction of insulin-like growth factor 1 (IGF-1) plasma levels is associated with the degree of liver dysfunction and mortality in cirrhotic patients. However, little research is available on the recovery of the IGF-1 level and its prognostic role after liver transplantation (LT).
From April 2010 to May 2011, 31 patients were prospectively enrolled (25/6 M/F; mean age±SEM: 55.2±1.4 years), and IGF-1 serum levels were assessed preoperatively and at 15, 30, 90, 180 and 365 days after transplantation. The influence of the donor and recipient characteristics (age, use of extended criteria donor grafts, D-MELD and incidence of early allograft dysfunction) on hormonal concentration was analyzed. The prognostic role of IGF-1 level on patient survival and its correlation with routine liver function tests were also investigated.
All patients showed low preoperative IGF-1 levels (mean±SEM: 29.5±2.1), and on postoperative day 15, a significant increase in the IGF-1 plasma level was observed (102.7±11.7 ng/ml; p<0.0001). During the first year after LT, the IGF-1 concentration remained significantly lower in recipients transplanted with older donors (>65 years) or extended criteria donor grafts. An inverse correlation between IGF-1 and bilirubin serum levels at day 15 (r = -0.3924, p = 0.0320) and 30 (r = -0.3894, p = 0.0368) was found. After multivariate analysis, early (within 15 days) IGF-1 normalization [Exp(b) = 3.913; p = 0.0484] was the only prognostic factor associated with an increased 3-year survival rate.
IGF-1 postoperative levels are correlated with the graft's quality and reflect liver function. Early IGF-1 recovery is associated with a higher 3-year survival rate after LT.
胰岛素样生长因子1（IGF-1）血浆水平降低与肝硬化患者的肝功能障碍程度及死亡率相关。然而，关于肝移植（LT）后IGF-1水平的恢复情况及其预后作用的研究较少。
2010年4月至2011年5月，前瞻性纳入31例患者（男25例/女6例；平均年龄±标准误：55.2±1.4岁），于术前及移植后15、30、90、180和365天评估IGF-1血清水平。分析供体和受体特征（年龄、扩展标准供体移植物的使用、D-MELD及早期移植物功能障碍发生率）对激素浓度的影响。还研究了IGF-1水平对患者生存的预后作用及其与常规肝功能检查的相关性。
所有患者术前IGF-1水平均较低（平均±标准误：29.5±2.1），术后第15天，IGF-1血浆水平显著升高（102.7±11.7 ng/ml；p<0.0001）。在LT后的第一年，接受年龄较大供体（>65岁）或扩展标准供体移植物移植的受者中，IGF-1浓度仍显著较低。发现第15天（r = -0.3924，p = 0.0320）和第30天（r = -0.3894，p = 0.0368）时IGF-1与血清胆红素水平呈负相关。多因素分析后，早期（15天内）IGF-1恢复正常[Exp(b)=3.913；p = 0.0484]是与3年生存率提高相关的唯一预后因素。
术后IGF-1水平与移植物质量相关并反映肝功能。LT后早期IGF-1恢复与较高的3年生存率相关。
