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Effects of isolated small bowel transplantation on liver dysfunction caused by intestinal failure and long‐term total parenteral nutrition
Author(s) -
Hasegawa Toshimichi,
Sasaki Takashi,
Kimura Takuya,
Nakai Hiroshi,
Sando Kinya,
Wasa Masafumi,
Takagi Yoji,
Okada Akira,
Mushiake Sohtarou,
Harada Tokuzou
Publication year - 2002
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1034/j.1399-3046.2002.01074.x
Subject(s) - medicine , parenteral nutrition , gastroenterology , steatosis , cholestasis , hepatosplenomegaly , liver transplantation , liver biopsy , transplantation , sepsis , surgery , biopsy , disease
It has not been fully determined whether isolated small bowel transplantation (ISBTx) can reverse liver dysfunction caused by intestinal failure requiring long‐term total parenteral nutrition (TPN). A boy with congenital microvillus inclusion disease presented with vomiting and severe diarrhea since the first day of life and had been managed by TPN since then. He suffered from catheter‐related sepsis several times. At 14 yr of age he developed progressive hepatosplenomegaly with thrombocytopenia and coagulopathy. He underwent ISBTx with an ileal graft from his blood‐identical grandmother at the age of 16 yr. Oral feeding was started on the 14th day after ISBTx and gradually increased. TPN was completely withdrawn after 5 months. Liver was palpated 5 cm below the costal margin before ISBTx, while it became non‐palpable 5 months after ISBTx. Serum liver enzyme levels and prothrombin time normalized in the 5 months following ISBTx. Liver biopsy showed marked steatosis, slight cholestasis, and mild bridging fibrosis before ISBTx. Although histological examination of liver biopsy revealed complete disappearance of steatosis 7 and 11 months after ISBTx, liver fibrosis remained unchanged. This clinical experience has shown that although steatosis and cholestasis are reversible after successful ISBTx and withdrawal of TPN, liver fibrosis may remain unchanged.