title: Effects of isolated small bowel transplantation on liver dysfunction caused by intestinal failure and long-term total parenteral nutrition.
abstract: 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 TPN was completely withdrawn after 5 months.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.
authors.affiliation: Department of Pediatric Surgery, Osaka University Medical School, Suita City, Osaka, Japan. toshi@pedsurg.med.osaka-u.ac.jp
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Takuya
authors.initials: T
authors.lastname: Kimura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakai
authors.forename: Kinya
authors.initials: K
authors.lastname: Sando
authors.forename: Masafumi
authors.initials: M
authors.lastname: Wasa
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takagi
authors.forename: Akira
authors.initials: A
authors.lastname: Okada
authors.forename: Sohtarou
authors.initials: S
authors.lastname: Mushiake
authors.forename: Tokuzou
authors.initials: T
authors.lastname: Harada
mesh_terms: D000293:Adolescent; D006801:Humans; D002479:Inclusion Bodies / Q000473:pathology; D007410:Intestinal Diseases / Q000151:congenital / Q000628:therapy*; D007421:Intestine, Small / Q000637:transplantation*; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology; D008107:Liver Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008871:Microvilli / Q000473:pathology; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*