Growth Hormone Therapy in Liver Cirrhosis
Growth Hormone Therapy in Liver Cirrhosis
Liver cirrhosis (LC) is a leading cause of morbidity and mortality worldwide. Life-
 threatening complications of liver cirrhosis are ascites, gastrointestinal bleeding, variceal
 bleed, hepatic encephalopathy and hepatocellular carcinoma (HCC) which are associated with
 poor prognosis.The leading causes of liver cirrhosis include excess alcohol consumption,
 viral hepatitis and non-alcoholic fatty liver disease. Malnutrition is common in end-stage
 liver disease (cirrhosis) and is often associated with a poor prognosis. It occurs in all
 forms of cirrhosis with different etiology and prevalence ranges from 65 to 100% depending
 upon the methods used for nutritional assessment and the severity of liver disease.
 Nutritional state influences survival in patients with decompensated cirrhosis. Protein
 malnutrition manifested by reduced skeletal muscle mass and hypoalbuminemia, exist in
 patients with cirrhosis despite apparent adequate food consumption and these patients have a
 higher rate of complications and, overall, an increased mortality rate. Also, Malnutrition
 has significant implications for liver transplantation; patients with poor nutritional status
 before transplantation have increased complications and higher mortality rates
 postoperatively. Screening all patients with chronic liver disease for nutritional
 abnormalities can identify those at risk of developing preventable complications.

 Malnutrition is commonly associated with protein catabolism and the protein catabolic state
 of cirrhosis is associated with severe growth hormone (GH) resistance, with low levels of
 insulin-like growth factor (IGF)-I and its major binding protein (IGFBP)-3.

 GH therapy in cirrhosis has been shown to improve nitrogen economy and to improve the GH
 resistance in a small pilot study by Donaghy et al. Also, GH therapy of short duration has
 shown to increase IGF1 levels, IGFBP-3 levels in patients of cirrhosis. GH therapy has also
 shown to improve liver regeneration and protein synthesis after hepatectomy in patients of
 HCC with cirrhosis.

 However there is scarcity of data on clinical impact of long term administration of GH
 therapy in patients of cirrhosis. Hence, we undertook the present study to study the effect
 of growth hormone on nitrogen economy, malnutrition and liver regeneration in patients with
 cirrhosis.
Inclusion Criteria:

 -  Decompensated Cirrhosis of liver irrespective of etiology

 Exclusion Criteria:

 -  Acute on chronic liver failure (fulfilling either APASL or CANONIC criteria of ACLF)

 -  Splenic diameter of more than 18 cm

 -  Concomitant HCC or other active malignancy

 -  Upper gastrointestinal bleeding in the previous 7 days

 -  Portal vein thrombosis

 -  Severe renal dysfunction as defined by creatnine > 1.5mg/dl

 -  Severe cardiac dysfunction

 -  Uncontrolled diabetes (Hb A 1c ≥ 9) or diabetic retinopathy

 -  Acute infection or disseminate intravascular coagulation

 -  Active alcohol abuse in last 3 months

 -  Known hypersensitivity to GH

 -  HIV co-infection

 -  Pregnancy

 -  Refusal to give informed consent