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Persistent abnormal liver fibrosis after weaning off parenteral nutrition in pediatric intestinal failure
Author(s) -
Mutanen Annika,
Lohi Jouko,
Heikkilä Päivi,
Koivusalo Antti I.,
Rintala Risto J.,
Pakarinen Mikko P.
Publication year - 2013
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.26360
Subject(s) - gastroenterology , medicine , parenteral nutrition , cholestasis , histology , weaning , steatosis , fibrosis , bilirubin , liver biopsy , biopsy
The aim of this study was to evaluate the long‐term effects of pediatric intestinal failure (IF) on liver histology. Altogether, 38 IF patients (median age: 7.2 years; range, 0.2‐27) underwent liver biopsy, gastroscopy, abdominal ultrasound, and laboratory tests. Sixteen patients were on parenteral nutrition (PN) after 74 PN months (range, 2.5‐204). Twenty‐two had weaned off PN 8.8 years (range, 0.3‐27) earlier, after 35 PN months (range, 0.7‐250). Fifteen transplant donor livers served as controls. Abnormal liver histology was found in 94% of patients on PN and 77% of patients weaned off PN ( P = 0.370). During PN, liver histology weighted with cholestasis (38% of patients on PN versus 0% of patients weaned off PN; P = 0.003) and portal inflammation (38% versus 9%; P = 0.050) were found. Fibrosis (88% versus 64%; P = 0.143; Metavir stage: 1.6 [range, 0‐4] versus 1.1 [range, 0‐2]; P = 0.089) and steatosis (50% versus 45%; P = 1.000) were equally common during and after weaning off PN. Plasma alanine aminotransferase (78 U/L [range, 19‐204] versus 34 [range, 9‐129]; P = 0.009) and conjugated bilirubin (43 μmol/L [range, 1‐215] versus 4 [range, 1‐23]; P = 0.037) were significantly higher during than after weaning off PN. Esophageal varices were encountered in 1 patient after weaning off PN. Metavir stage was associated with small bowel length ( r = −0.486; P = 0.002) and number of septic episodes ( r = 0.480; P = 0.002). In a multivariate analysis, age‐adjusted small bowel length (ß = −0.533; P = 0.001), portal inflammation (ß = 0.291; P = 0.030), and absence of an ileocecal valve (ß = 0.267; P = 0.048) were predictive for fibrosis stage. Conclusion : Despite resolution of cholestasis and portal inflammation, significant liver fibrosis and steatosis persist after weaning off PN. Extensive small intestinal resection was the major predictor for liver fibrosis stage. (H epatology 2013;58:729–738)