Endocrine Abstracts

Background: Linear growth is often impaired after successful liver transplantation. Factors that negatively impacted growth are age, graft function and corticosteroid immunosuppression. Short-statured prepubertal liver transplant recipients who do not show sufficient compensatory growth after transplantation benefit from treatment with recombinant human growth hormone (rhGH).

Cas report: We communicate the results after the first year of rhGH treatment in a child of 12 years old, identified with growth failure after a liver transplantation. Liver transplant (live donor- the mother) to 9 years for secondary cirrhosis (biliary atresia), malabsorption syndrome, secondary osteoporosis with multiple femoral fractures on pathological bone. Height =108 cm (− 5, 92 SDS), and the weight was =20 kg (−2, 5 SDS). Bone age =7 years. Bone mineral density (BMD- DXA)-whole body=0.718 g/cm² (low bone mass acquisition). Blood samples for baseline growth hormone (GH) secretion, serum insulin-like growth factor (IGF-I) concentrations serum alkaline phosphatase, alanine aminotransferase, y-glutamyl transferase, and total bilirubin concentration, serum free T, and TSH levels were determined every 6 months. He was treated with subcutaneous injections of rhGH at 0.35 mg/kg/ wk. for one year. Treatment was begun after 3 years of x liver transplantation. He was treated for that with tacrolimus and prednisolone. After the first year, rhGH treatment was continued.

Results: After 12 months of treatment, median serum levels IGF-I increased from 86 to 231 ng/ml. Height velocity increased from 2 cm/yr. to 10,2 cm/yr. and BMD-DXA whole body from 0.718 g/cm² to 0.997 g/cm² (+38%); lean+BMC from 15735.6 g to 19510.5 g (+24%); fat decreased from 4378 g to 2990.7 (−32%); and total weight increased with 12%. There were no rejection episodes.

Conclusion: In our case rhGH treatment was effective in short, non-GH deficient, liver-transplanted child receiving long term glucocorticoid treatment.