title: Reappraisal of the Role of Portacaval Shunting in the Growth of Patients With Glycogen Storage Disease Type I in the Era of Liver Transplantation.
abstract: BACKGROUND
  Instead of dietary modification, surgical management is considered for correcting growth retardation, poor metabolic control, and hepatocellular adenoma (HCA) in glycogen storage disease (GSD) type I.
  
  
  METHODS
  The records of 55 GSD type I patients were retrospectively reviewed. Thirty-two patients underwent only dietary management (group D) and 23 underwent surgical management (group S). In group S, 17 underwent portacaval shunting (PCS), 13 underwent liver transplantation (LT; 7 underwent both PCS and LT). Height-for-age and body mass index-for-age Z-scores based on World Health Organization data were used to compare growth patterns before and after surgery. Changes in metabolic abnormalities and HCA after operation were also investigated.
  
  
  RESULTS
  Height-for-age Z-scores for group S were higher by an average of 0.377 compared to that for group D. Metabolic abnormalities often disappeared after LT but improved partially after PCS. De novo HCA was detected in 4 patients (13%) from group D, 12 (100%) who underwent PCS, and none who underwent LT. One case of hepatocellular carcinoma and one of hemorrhage from a HCA were noted in group D. Two cases of hepatocellular carcinoma, 2 of hemorrhage, and 1 of necrosis were noted after PCS.
  
  
  CONCLUSIONS
  Surgery yielded greater growth improvement than dietary management. However, after PCS, metabolic abnormalities remained unresolved, and the de novo HCA rate was high. Portacaval shunting can be used to improve growth in GSD type I patients when LT is not possible, but close observation for metabolic abnormalities and HCA is essential.
authors.affiliation: 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea. 2 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 3 Department of Pediatrics and Adolescent Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: YoungRok
authors.initials: Y
authors.lastname: Choi
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Ko
authors.forename: Jin-Soo
authors.initials: JS
authors.lastname: Moon
authors.forename: Suk-Won
authors.initials: SW
authors.lastname: Suh
authors.forename: Jeong-Moo
authors.initials: JM
authors.lastname: Lee
authors.forename: Jae-Hong
authors.initials: JH
authors.lastname: Jeong
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Kim
authors.forename: Hae-Won
authors.initials: HW
authors.lastname: Lee
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
mesh_terms: D018248:Adenoma, Liver Cell / Q000209:etiology / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001827:Body Height; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005953:Glycogen Storage Disease Type I / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000517:prevention & control; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008659:Metabolic Diseases / Q000209:etiology / Q000517:prevention & control; D011167:Portacaval Shunt, Surgical / Q000009:adverse effects / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult