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Serum growth factors and growth indices pre- and post-pediatric intestinal transplantation
Anita M Nucci1, Jorge Reyes, Jane Anne Yaworski
1Clinical Nutrition Department, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
Insights
Pretransplant insulin-like growth factor levels may predict growth outcomes in children after intestinal transplantation. Low pretransplant IGF-1 and IGFBP-3 were linked to poor growth, highlighting the need for nutritional support.
Area of Science:
- Pediatric Gastroenterology
- Transplantation Immunology
- Pediatric Endocrinology
Background:
- Intestinal transplantation (ITx) frees children from parenteral nutrition but often fails to promote adequate growth.
- Evaluating growth factors is crucial for understanding post-ITx development.
Purpose of the Study:
- To assess serum growth factor levels (IGF-1, IGFBP-3) in relation to growth and nutritional status in pediatric ITx recipients.
- To identify potential predictors of growth post-intestinal transplantation.
Main Methods:
- Retrospective review of serum IGF-1 and IGFBP-3 levels before and after ITx in pediatric patients.
- Calculation of weight and height Z-scores for 2 years post-transplant.
Main Results:
- Most patients had low pre-ITx IGF-1 (60%) and IGFBP-3 (67%).
- Post-ITx growth factor levels normalized or increased, but significant growth was limited.
- Low pre-ITx IGF-1 and IGFBP-3 correlated with negative linear growth velocity in some patients.
Conclusions:
- Pretransplant growth factor levels may predict the need for intensive nutritional rehabilitation post-ITx.
- Absorption studies are recommended to guide nutrient management for optimal growth in post-ITx children.
Background/Purpose:
Although intestinal transplantation (ITx) has succeeded in liberating children with intestinal failure from total parenteral nutrition (TPN), positive growth has yet to be achieved in the majority of patients. This investigation aims to evaluate levels of serum growth factors as they relate to growth parameters and nutritional outcomes.
Methods:
Serum measures of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) that had been obtained before and after transplantation were reviewed (with Institutional Review Board approval) in a subset of pediatric ITx recipients. Z-scores for weight and height were calculated at transplant and biannually thereafter for 2 years.
Results:
Five children received a small bowel/liver transplant between August 1996 and March 2000 (median age, 1.3 years). Before transplantation, levels of IGF-1 and IGFBP-3 were low in 60% and 67% of patients, respectively. Posttransplant levels of these growth factors were within normal limits or elevated in all but 2 patients (IGFBP-3 only). A positive trend in z-scores was observed in just one of 5 patients for weight and in 2 of 5 for height/length during the follow-up period. Of the 3 patients who experienced negative linear growth velocity over time, 2 had low pretransplant levels of both IGF-1 and IGFBP-3. All patients were weaned from TPN within 3 months after transplant.
Conclusions:
Pretransplant levels of growth mediators may be predictive factors in children who will require an intensive regimen of nutritional rehabilitation posttransplant to promote the growth process. Absorption studies may aid in determining the appropriate nutrient substrates for the post-ITx population.
