Rapid reversal of parenteral-nutrition-associated cirrhosis following isolated intestinal transplantation.
BACKGROUND
Liver disease and the development of hepatic fibrosis are complications associated with total parenteral nutrition (TPN). Patients developing cirrhosis and portal hypertension in the setting of intestinal failure have a high mortality and may require combined liver and intestinal transplantation which carries much higher morbidity and mortality than isolated intestinal transplantation.


CONCLUSIONS
Recently, regression of hepatic fibrosis in patients with TPN liver disease has been described following intestinal transplantation. To date, there has been no demonstration of the reversal of established cirrhosis due to long-term TPN injury. Herein, we describe a patient with intestinal failure who developed cirrhosis from long-standing TPN injury and underwent isolated intestinal transplantation. He had no overt clinical stigmata of portal hypertension and had preserved liver function. Serial liver biopsies were reviewed and assessed with standard histology and quantitation of fibrosis using image analysis. Dramatic regression of fibrosis and reversal of cirrhosis were observed 17 months posttransplantation. Image analysis demonstrated a 14% total decrease in the percentage area of fibrosis.


CONCLUSIONS
Cirrhosis related to TPN may be rapidly reversible after isolated intestinal transplantation. Such patients may be able to undergo isolated intestinal transplantation if they do not have hepatic synthetic compromise or clinical stigmata of portal hypertension.
Lillian and Henry M Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, NY 10029, USA. mariaisabel.fiel@MountSinai.org
M Isabel
MI
Fiel
Hai-Shan
HS
Wu
Kishore
K
Iyer
Gonzalo
G
Rodriguez-Laiz
Thomas D
TD
Schiano
D000328:Adult; D001707:Biopsy, Needle; D002908:Chronic Disease; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000473:pathology; D007150:Immunohistochemistry; D007418:Intestinal Pseudo-Obstruction / Q000473:pathology / Q000601:surgery*; D007421:Intestine, Small / Q000637:transplantation*; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects* / Q000379:methods; D011184:Postoperative Period; D020127:Recovery of Function; D012720:Severity of Illness Index; D013163:Splenomegaly / Q000209:etiology / Q000473:pathology; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome