title: Prevalence of liver complications in children receiving long-term parenteral nutrition.
abstract: OBJECTIVE
  The hepatic prognosis of long-term home total parenteral nutrition (TPN)-dependent children is poorly documented. The objective was 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.
  
  
  METHODS
  Medical records of 42 children receiving home TPN for more than 2 years between January 1998 and December 2007 in a single approved home total 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 (mean±s.e.m.), with an average age at onset of 1.5±0.5 years. A total of 24 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 commencement, longer duration of TPN, higher rate of catheter-related infections and higher volume and energy content of TPN. Liver biopsies were carried out 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.
  
  
  CONCLUSIONS
  Our study reports a high rate of histological liver abnormalities and analyzes risk factors in children who underwent very long-term home TPN.
authors.affiliation: Pediatric department CHR Annecy, Lyon, France.
authors.forename: B
authors.initials: B
authors.lastname: Peyret
authors.forename: S
authors.initials: S
authors.lastname: Collardeau
authors.forename: S
authors.initials: S
authors.lastname: Touzet
authors.forename: I
authors.initials: I
authors.lastname: Loras-Duclaux
authors.forename: H
authors.initials: H
authors.lastname: Yantren
authors.forename: M C
authors.initials: MC
authors.lastname: Michalski
authors.forename: J
authors.initials: J
authors.lastname: Chaix
authors.forename: L
authors.initials: L
authors.lastname: Restier-Miron
authors.forename: R
authors.initials: R
authors.lastname: Bouvier
authors.forename: A
authors.initials: A
authors.lastname: Lachaux
authors.forename: N
authors.initials: N
authors.lastname: Peretti
mesh_terms: D000367:Age Factors; D001706:Biopsy; D055499:Catheter-Related Infections / Q000150:complications; D002675:Child, Preschool; D002779:Cholestasis / Q000209:etiology*; D004041:Dietary Fats / Q000008:administration & dosage; D002149:Energy Intake; D005234:Fatty Liver / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D007422:Intestines / Q000033:anatomy & histology; D008055:Lipids / Q000008:administration & dosage; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D008297:Male; D016562:Parenteral Nutrition, Home Total / Q000009:adverse effects*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012778:Short Bowel Syndrome / Q000150:complications
chemical_list: D004041:Dietary Fats; D008055:Lipids