Parenteral nutrition–associated liver disease and the role for isolated intestine and intestine/liver transplantation

Authors

  • Alan L. Buchman,

    Corresponding author
    1. Division of Gastroenterology, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University Chicago, IL
    • 676 N. St. Clair St, Suite 1400, Chicago, IL 60611
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    • fax: 312-695-3999

  • Kishore Iyer,

    1. Division of Hepatology, Northwestern Memorial Hospital, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University Chicago, IL
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  • Jonathan Fryer

    1. Division of Transplantation Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University Chicago, IL
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  • Potential conflict of interest: Dr. Buchman is a consultant for Serono, Inc and NPS/Allelix, Inc. He states he has intellectual property rights for Choline Chloride.

Abstract

Parenteral nutrition–associated liver disease (PNALD) is the most devastating complication of long-term parenteral nutrition therapy. Because its progression is typically insidious and its long-term consequences are generally underappreciated, PNALD is often recognized too late, when liver injury is irreversible. When end-stage liver disease (ESLD) develops in these patients, most potential interventions are futile and transplantation of both an intestine and a liver becomes the only viable option, despite the relatively poor outcomes associated with this combined procedure. Although likely multifactorial in origin, the etiology of PNALD is poorly understood. Early clinical intervention with a combination of nutritional, medical, hormonal, and surgical therapies can be effective in preventing liver disease progression. If these interventions fail, intestinal transplantation should be performed expeditiously before development of ESLD mandates simultaneous inclusion of a liver graft as well. (HEPATOLOGY 2006;43:9–19.)

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