title: Hepatic explant pathology of pediatric intestinal transplant recipients previously treated with omega-3 fatty acid lipid emulsion.
abstract: OBJECTIVE
  To evaluate and compare the biochemical and histologic effect of parenteral fish oil lipid emulsion that is rich in omega-3 polyunsaturated fatty acids (O3FAs), Omegaven (Fresenius Kabi AG, Bad Homburg, Germany) with standard omega-6 polyunsaturated fatty acid (O6FA) parenteral nutrition.
  
  
  METHODS
  Comparison of hepatic explant pathology and biochemical outcome on pediatric patients with intestinal failure treated with either parental O3FA or O6FA who had received a liver-inclusive intestine transplant.
  
  
  RESULTS
  Seven liver-inclusive intestinal transplants were performed in 7 patients who received O3FA for a mean of 62% ± 13% of total patient life-span (16.1 ± 7.0 months) before transplant. Median total bilirubin fell from 6.9 mg/dL at the start of treatment to 0.7 mg/dL at the time transplant (P < .02), which was a significant decrease compared with the similarly matched O6FA cohort (P = .012). All 7 of the 03FA-treated patients received a liver-inclusive intestinal transplant had advanced fibrosis (stage 3 or 4) noted on explant pathologic examination, despite a resolution of cholestasis at the time of transplant. Histologic inflammatory scores were lower (P = .056) in the 03FA group with similar degrees of advanced fibrosis as in the O6FA group.
  
  
  CONCLUSIONS
  In a matched comparison of patients undergoing intestinal transplantation with a history of extended O3FA lipid emulsion therapy that successfully reversed hyperbilirubinemia, significant hepatic fibrosis was present in the explanted livers despite a reduction in inflammation. This result confirms concern that the use of O3FA may have a limited role in altering the development of hepatic fibrosis from parenteral nutrition.
authors.affiliation: MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC. Electronic address: csm5@gunet.georgetown.edu.
authors.forename: Cal S
authors.initials: CS
authors.lastname: Matsumoto
authors.affiliation: MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC.
authors.forename: Stuart S
authors.initials: SS
authors.lastname: Kaufman
authors.affiliation: MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC.
authors.forename: Eddie R
authors.initials: ER
authors.lastname: Island
authors.affiliation: Department of Pathology, MedStar Georgetown University Hospital, Washington, DC.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Kallakury
authors.affiliation: MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC.
authors.forename: Nada A
authors.initials: NA
authors.lastname: Yazigi
authors.affiliation: MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC.
authors.forename: Khalid M
authors.initials: KM
authors.lastname: Khan
authors.affiliation: MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Fishbein
mesh_terms: D001663:Bilirubin / Q000097:blood; D002675:Child, Preschool; D005217:Fat Emulsions, Intravenous; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D006932:Hyperbilirubinemia / Q000628:therapy*; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery / Q000628:therapy*; D007422:Intestines / Q000637:transplantation*; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D016896:Treatment Outcome; D014280:Triglycerides
chemical_list: D005217:Fat Emulsions, Intravenous; D043371:Fatty Acids, Omega-6; D005395:Fish Oils; D014280:Triglycerides; C568345:fish oil triglycerides; D001663:Bilirubin