title: Liver Disease in Pediatric Patients With Ataxia Telangiectasia: A Novel Report.
abstract: OBJECTIVE
  Ataxia telangiectasia (A-T) is a rare genetic multiorgan disease. Although gastrointestinal involvement is known, hepatic involvement in A-T has not been investigated. We aimed to study the hepatic involvement in a large cohort of patients with A-T.
  
  
  METHODS
  A retrospective review of patients, studied from January 1986 to January 2015 at a National A-T Center. Clinical data including demographic, genetic, laboratory, nutritional, radiographic, and histological data were retrieved.
  
  
  RESULTS
  Fifty-three patients, 27 (49%) boys, age 14.6 ± 5.2 years (range 5.9-26.1 years), were included. Twenty-three patients (43.4%), age 9.9 ± 5.1 years, had consistently abnormal liver enzymes. The mean enzyme levels were alanine aminotransferase 76.8 ± 73.8 IU/L, aspartate aminotransferase 70 ± 50 IU/L, alkaline phosphatase 331 ± 134 IU/L, and gamma glutamyl transferase 114.7 ± 8 IU/L. Evaluation of other etiology of liver disease was negative. Ultrasonography revealed fatty liver in 9 of them (39%). Liver biopsy was performed in 2 patients, revealing mild-to-moderate steatosis in both, and fibrosis in 1 patient. Progression to advanced liver disease occurred in 2 of 23 (9%) patients within 2 to 5 years. Dyslipidemia was significantly associated with abnormal liver enzymes: 3 of 30 (10%) patients without abnormal liver enzymes versus 10 of 23 (45.5%) patients with abnormal liver enzymes, respectively (P < 0.05, Fisher exact test). No correlation was found between hepatic involvement and HbA1C, sex, presence of malignancy, or type of mutation.
  
  
  CONCLUSIONS
  Abnormal liver enzymes and fatty liver are common in patients with A-T and may progress to advanced liver disease at a young age. These findings are novel and implicate that patients with A-T with abnormal liver enzymes should be evaluated for the presence of liver disease.
authors.affiliation: *Pediatric Gastroenterology and Nutrition Unit †Department of Pediatrics, and Pediatric Immunology ‡Pediatric Radiology Unit §Pediatric Pulmonology Unit and Ataxia Telangiectasia Center ||Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Tel-Hashomer, Tel Aviv University, Israel.
authors.forename: Batia
authors.initials: B
authors.lastname: Weiss
authors.forename: Alexander
authors.initials: A
authors.lastname: Krauthammer
authors.forename: Michalle
authors.initials: M
authors.lastname: Soudack
authors.forename: Avishay
authors.initials: A
authors.lastname: Lahad
authors.forename: Ifat
authors.initials: I
authors.lastname: Sarouk
authors.forename: Raz
authors.initials: R
authors.lastname: Somech
authors.forename: Gali
authors.initials: G
authors.lastname: Heimer
authors.forename: Bruria
authors.initials: B
authors.lastname: Ben-Zeev
authors.forename: Andreea
authors.initials: A
authors.lastname: Nissenkorn
mesh_terms: D000293:Adolescent; D000328:Adult; D001260:Ataxia Telangiectasia / Q000097:blood / Q000235:genetics / Q000503:physiopathology*; D064007:Ataxia Telangiectasia Mutated Proteins / Q000235:genetics; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D050171:Dyslipidemias / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D009154:Mutation; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult
chemical_list: C576324:ATM protein, human; D064007:Ataxia Telangiectasia Mutated Proteins