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Persistent alanine aminotransferase elevations in children with parenteral nutrition-associated liver disease

Chi-Fu Jeffrey Yang1, Michele Lee, Clarissa Valim

  • 1Harvard Medical School, Boston, MA 02115, USA.

Journal of Pediatric Surgery
|June 16, 2009
PubMed

Insights

Children with parenteral nutrition-associated liver disease (PNALD) often have persistent elevated alanine aminotransferase (ALT) levels, indicating ongoing liver injury even after direct bilirubin normalizes and they achieve enteral nutrition independence.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Clinical Nutrition

Background:

  • Parenteral nutrition-associated liver disease (PNALD) is a significant complication in children with short bowel syndrome.
  • Early identification and monitoring of liver injury are crucial for managing PNALD.

Purpose of the Study:

  • To longitudinally assess serum alanine aminotransferase (ALT) levels in children with PNALD who are transitioning to enteral nutrition.
  • To evaluate the correlation between ALT normalization and direct bilirubin levels in this cohort.

Main Methods:

  • Retrospective chart review of 31 pediatric patients with PNALD.
  • Analysis of patients who achieved full enteral nutrition tolerance after a minimum of 3 months of parenteral nutrition.
  • Kaplan-Meier and Cox proportional hazards methods were used to estimate time to normalization of ALT and direct bilirubin.

Main Results:

  • After transitioning to enteral nutrition, 74% of children normalized direct bilirubin, while only 50% normalized ALT.
  • Median time to direct bilirubin normalization was 13 weeks, compared to 35 weeks for ALT normalization (P = .001).
  • Persistent ALT elevation was observed in children with PNALD despite normalization of direct bilirubin.

Conclusions:

  • Children achieving enteral nutrition independence with PNALD may experience ongoing hepatic injury, as indicated by persistent ALT elevation.
  • ALT normalization lags behind direct bilirubin normalization, suggesting a prolonged recovery period for liver function.
  • This study highlights the importance of monitoring ALT beyond bilirubin levels in children recovering from PNALD.
Abstract

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