Parenteral nutrition-associated liver disease and the role for isolated intestine and intestine/liver transplantation
Parenteral nutrition-associated liver disease and the role for isolated intestine and intestine/liver transplantation
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DOI：
10.1002/hep.20997
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发表时间：
2006-01-01
期刊：
影响因子：
13.5
通讯作者：
Fryer, J
中科院分区：
文献类型：
--
作者：
Buchman, AL;Iyer, K;Fryer, J
肠外营养相关性肝病（PNALD）是长期肠外营养治疗最具破坏性的并发症。由于其进展通常是阴险的，其长期后果通常被低估，PNALD往往被发现得太晚，当肝损伤是不可逆的。当这些患者发生终末期肝病（ESLD）时，大多数潜在的干预措施都是徒劳的，肠和肝脏移植成为唯一可行的选择，尽管这种联合手术的结果相对较差。虽然PNALD的病因可能是多因素引起的，但目前尚不清楚。早期临床干预结合营养，药物，激素和手术治疗可以有效预防肝病进展。如果这些干预措施失败，应在ESLD发展要求同时纳入肝移植之前迅速进行肠移植。
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.