Growth, Insulin-Like Growth Factor I (IGF-I), and IGF-Binding Proteins 1 and 3 in Children with Severe Liver Disease before and after Liver Transplantation: A Longitudinal and Cross-Sectional Study

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We aimed to study the growth and growth factors of children with liver disease before and after liver transplantation (LT). Three observation intervals: 1) before LT (preLT), 2) after LT on daily prednisone treatment (dP), and 3) on alternate day prednisone (adP). A longitudinal study (LS) involved 17 infants (9 male) aged 0.73-2.38 y at LT; mean (±SD) height (Ht) SD score (SDS) at LT was -2.02 (± 1.25). In a cross-sectional study, there were 123 children (73 male) aged 0.16-14.88 y (mean 3.72 y). IGF-I and IGF binding proteins (BP) 1 and 3 were measured at the same intervals. The results were, for LS, preLT height velocity (HV) SDS(-X ± SD -0.8 ± 1.4) lower (p < 0.01) than adP-HV SDS (3.1 ± 1.8) but not different from dp-HV SDS(-1.0 ± 1.9). For the cross-sectional study, dP-Ht SDS(-X ± SD -1.94 ± 1.31) lower (p < 0.001) than preLT-Ht SDS (-1.03 ± 1.06) and adP-Ht SDS (-0.98 ± 1.20). Parental target SDS was not different from adP-Ht SDS. (Similar observations were made in the LS.) The dP- sitting height (SH) and subischial leg length (SLL) SDS were significantly lower than both preLT- and adP-SH SDS and SLL SDS (p = 0.02 and 0.002, respectively). There was a significant improvement of head circumference SDS and arm circumference SDS from preLT to adP. The dP and adP IGF-I and IGF-BP3 levels were greater than preLT levels (p < 0.001); no differences were found between preLT, dP, and adP IGF-BP1 levels. We conclude that growth in children with liver disease does not improve after LT on dP, but catch-up growth is shown on adP, appearing to depend mainly on the clinical course and corticosteroid regimen. IGF-I and IGF-BP3 increment on dP (and sustained on adP) is possibly due to liver regeneration, in contrast with inhibition of body growth on dP, possibly due to central and peripheral effects of corticosteroid.

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