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July 18, 2014 7:00 am
Many have advocated for the use of parenteral fish oil lipids like Omegaven which are rich in omega-3 polyunsaturated fatty acids (O3FAs), though the data in support of them are limited (New lipid emulsions — lacking data to support usage …).
A recent study (J Pediatr 2014; 165: 59-64) identified seven liver-inclusive intestinal transplants who had received O3FAs. This retrospective review study took place between 2003-2012. These seven patients had received O3FAs for a mean of 62% of their total life span before transplant. While these patients almost all had resolution of cholestasis (mean total bilirubin 0.7 mg/dL at time of transplant), advanced fibrosis (stage 3 or 4) was noted on explant pathology. The histologic inflammatory scores were lower (P=.056) in comparison to O6FA group.
The authors make several important points:
This is not the first study that indicates that liver fibrosis may persist and progress on O3FA therapy (J Pediatr 2010; 156: 327-31, J Pediatr Surg 2010; 45: 95-9, JPGN 2013; 56: 364-9).
Bottomline: Continued investigation of O3FA emulsions in PNALD is needed and assessing liver histology may be needed prior to intestinal transplantation.
Related blog posts:
Posted by gutsandgrowth
Categories: Pediatric Gastroenterology Intestinal Disorder
Tags: intestinal failure associated liver disease, intestinal transplantation, liver fibrosis, omega-3 lipid emulsions, omegaven, PNALD
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