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Prevalence of Liver Complications in Children Receiving Long-Term Parenteral Nutrition
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Edité par CCSD ; Nature Publishing Group -
International audience. BACKGROUND: The hepatic prognosis of long-term home total parenteral nutrition (TPN)-dependent children is poorly documented. OBJECTIVE: To study outcome data in home TPN-dependent children and to describe precisely their liver biopsies in the attempt to analyze risk factors for biochemical and histological hepatic abnormalities. PATIENTS AND METHODS: Medical reports of 42 children receiving home TPN for more than 2 years between January 1998 and December 2007 in a single approved home parenteral center were reviewed. Hepatic biochemical abnormalities were analyzed. Hepatic biopsies were classified by two independent pathologists. RESULTS: Duration of TPN was 7.9 ± 0.8 years (m ± SEM), with an average age at onset of 1.5 ± 0.5 years. Twenty four patients (57%) developed biochemical liver abnormalities in an average of 2.9 ÷ 0.4 years after starting TPN. Risk factors for biochemical abnormalities were younger age at TPN onset, longer duration of TPN, higher rate of catheter-related infections, and higher volume and energy content of TPN. Liver biopsies were performed in 43% of patients (mean age 3.2 ± 0.9 years). Almost all patients had fibrosis (94%). Risk factors were dependent on each histological abnormality: fibrosis was significantly associated with a shorter length of bowel and a longer duration of TPN; cholestasis correlated with a lower percentage of total parenteral energy intake due to lipids; and steatosis had no risk factor identified. CONCLUSION: Our study report a high rate of histological liver abnormalities and analyze risk factors in children who underwent very long-term home TPN. KEYWORDS: parenteral nutrition; liver disease; chronic disease; infant; child; adolescent; biopsy; fibrosis.
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