Parenteral nutrition–associated liver disease and the role for isolated intestine and intestine/liver transplantation†

Abstract

Parenteral nutrition-associated liver disease (PNALD) is the most devastating complication of long-term parenteral nutrition therapy. Because its progression is typically insidious and its long-term consequences are generally underappreciated, PNALD is often recognized too late, when liver injury is irreversible. When end-stage liver disease (ESLD) develops in these patients, most potential interventions are futile and transplantation of both an intestine and a liver becomes the only viable option, despite the relatively poor outcomes associated with this combined procedure. Although likely multifactorial in origin, the etiology of PNALD is poorly understood. Early clinical intervention with a combination of nutritional, medical, hormonal, and surgical therapies can be effective in preventing liver disease progression. If these interventions fail, intestinal transplantation should be performed expeditiously before development of ESLD mandates simultaneous inclusion of a liver graft as well. (HEPATOLOGY 2006;43:9-19.)

Melatonin protects liver from intestine ischemia reperfusion injury in rats

“…Although more and more powerful nonspecific immunosuppressive agents have been used in recent years, the rate of graft rejecting reaction is still higher than 50% in intestine [3] . Current clinical data show that combined liver and small intestine transplantation decreases both acute and chronic rejection compared with simple small intestine transplantation [4] . Small intestine transplantation, the best therapy for bowel dysfunction at present, cannot replace total parenteral nutrition (TPN) due to its severe rejecting reaction.…”

Incidence and Clinical Outcome of Acute Liver Failure Caused by Dengue in a Hospital for Tropical Diseases, Thailand

“…6,19 Impending liver failure was defined as liver dysfunction that did not meet the criteria for acute liver failure including nausea, vomiting, and laboratory investigations that showed increased serum bilirubin and/or liver enzymes, an increased PT and INR, and thrombocytopenia. 18,20 Data collection. The records of all patients were reviewed from the date of admission to the date of discharge.…”

PLP-Dependent Enzymes: a Potent Therapeutic Approach for Cancer and Cardiovascular Diseases

“…L-Methioninase was extensively tested a potent anti-proliferative enzyme towards Lewis lung (Yoshioka et al, 1998), human colon (Tan et al, 1998), glioblastoma (Kokkinakis et al, 2001), neuroblastoma (Hu and Cheung, 2009) as reviewed by Nozaki (2009) andEl-Sayed (2010). Recently, Parenteral nutrition is a common cosupportive strategy for various aspects of tumor therapy (Buchman et al, 2006). L-Methioninase was purified and characterized from different bacterial isolates (Hoffman and Erbe, 1976;Tanaka et al, 1977, Soda et al, 1983, Nikulin et al, 2008, particularly, Pseudomonas putida enzyme that extensively structurally studied via crystallographic studies (Ito et al, 1976, Tanaka et al, 1977, Nakayama et al, 1984, Motoshima et al, 2000, Kudou et al, 2007.…”