title: The IGF system after insertion of a transjugular intrahepatic porto-systemic shunt in patients with liver cirrhosis.
abstract: OBJECTIVE
  Insertion of a transjugular intrahepatic porto-systemic shunt (TIPS) into patients with liver cirrhosis usually induces a gain in body cell mass. Changes in the IGF system in favor of anabolism may be involved. We, therefore measured blood concentrations of the components of the IGF system in cirrhosis patients before and after elective TIPS.
  
  
  METHODS
  The study comprised 17 patients and 11 healthy controls. Patients were examined before and 1, 4, 12, and 52 weeks after TIPS. Biochemical analyses of the IGF system were compared with changes in body composition (bioimpedance analysis), glucose and insulin, and metabolic liver function (galactose elimination capacity).
  
  
  RESULTS
  After TIPS, body cell mass rose by 3.2 kg (95% confidence interval (CI): 1.0-5.5) at 52 weeks, in correlation with baseline liver function (r(2)=0.22; P=0.03). Peripheral blood concentrations of total IGF1 and 2, bioactive IGF1, and the IGF-binding proteins (IGFBP-1, -2, and -3) remained unchanged throughout the study period. There was no change in fasting glucose, whereas fasting insulin rose by 40% (CI: 11-77%) and glucagon by 58% (CI: 11-132%) from baseline to 52 weeks after TIPS.
  
  
  CONCLUSIONS
  Our data confirm that TIPS was associated with an increase in body cell mass in patients with liver cirrhosis, but without any change in the circulating IGF system. Thus, the results do not support the notion that effects on the circulating IGF system are involved in the anabolic effects of TIPS insertion.
authors.affiliation: Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark. phf@svf.au.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Holland-Fischer
authors.forename: Hendrik
authors.initials: H
authors.lastname: Vilstrup
authors.forename: Jan
authors.initials: J
authors.lastname: Frystyk
authors.forename: Dennis Tønner
authors.initials: DT
authors.lastname: Nielsen
authors.forename: Allan
authors.initials: A
authors.lastname: Flyvbjerg
authors.forename: Henning
authors.initials: H
authors.lastname: Grønbaek