title: Postoperative Insulin-Like Growth Factor 1 Levels Reflect the Graft's Function and Predict Survival after Liver Transplantation.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Hepatobiliary and Transplant Surgery, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Nicolini
authors.affiliation: Division of Hepatobiliary and Transplant Surgery, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Mocchegiani
authors.affiliation: Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Gioia
authors.initials: G
authors.lastname: Palmonella
authors.affiliation: Division of Hepatobiliary and Transplant Surgery, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Coletta
authors.affiliation: Division of Laboratory Medicine, Department of Services, A.O.U. "Ospedali Riuniti", Ancona, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Brugia
authors.affiliation: Division of Hepatobiliary and Transplant Surgery, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.affiliation: Division of Gastroenterology, Department of Gastroenterology and Transplantation, A.O.U. "Ospedali Riuniti", Ancona, Italy.
authors.forename: Giammarco
authors.initials: G
authors.lastname: Fava
authors.affiliation: Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: Taccaliti
authors.affiliation: Division of Liver and Kidney Transplant Surgery, Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
authors.affiliation: Division of Hepatobiliary and Transplant Surgery, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
mesh_terms: D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D005260:Female; D006085:Graft Survival; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011184:Postoperative Period; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors
chemical_list: D015415:Biomarkers; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I