Kathleen M Gura1, Muralidhar H Premkumar2, Kara L Calkins3, Mark Puder4. 1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pharmacy, Boston Children's Hospital, Boston, MA. Electronic address: Kathleen.gura@childrens.harvard.edu. 2. Baylor College of Medicine, Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Houston, TX. 3. Division of Neonatology & Developmental Biology, Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA. 4. Department of Surgery and the Vascular Biology Program (MPU), Boston Children's Hospital, Boston, MA.
Abstract
OBJECTIVE: To compare the aspartate aminotransferase to platelet ratio index, liver transplantation, and mortality rates between children with intestinal failure-associated liver disease who received fish oil lipid emulsion (FOLE) or soybean oil intravenous lipid emulsion (SOLE). STUDY DESIGN: In this multicenter integrated analysis, FOLE recipients (1 g/kg/d) (n = 189) were compared with historical controls administered SOLE (≤3 g/kg/d) (n = 73). RESULTS: Compared with SOLE, FOLE recipients had a higher direct bilirubin level at baseline (5.8 mg/dL vs 3.0 mg/dL; P < .0001). Among FOLE recipients, 65% experienced cholestasis resolution vs 16% of SOLE recipients (P < .0001). The aspartate aminotransferase to platelet ratio index scores improved in FOLE recipients (1.235 vs 0.810 and 0.758, P < .02) but worsened in SOLE recipients (0.540 vs 2.564 and 2.098; P ≤ .0003) when baseline scores were compared with cholestasis resolution and end of study, respectively. Liver transplantation was reduced in FOLE vs SOLE (4% vs 12%; P = .0245). The probability of liver transplantation in relation to baseline direct or conjugated bilirubin (DB) was lower in FOLE vs SOLE recipients (1% vs 9% at DB of 2 mg/dL; 8% vs 35% at DB of 12.87 mg/dL; P = .0022 for both). Death rates were similar (FOLE vs SOLE: 10% vs 14% at DB of 2 mg/dL; 17% vs 23% at a DB of 12.87 mg/dL; P = .36 for both). CONCLUSIONS: FOLE recipients experienced a higher rate of cholestasis resolution, lower aspartate aminotransferase to platelet ratio index, and fewer liver transplants compared with SOLE. This study demonstrates that FOLE may be the preferred parenteral lipid emulsion in children with intestinal failure-associated liver disease when DB reaches 2 mg/dL. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00910104 and NCT00738101.
OBJECTIVE: To compare the aspartate aminotransferase to platelet ratio index, liver transplantation, and mortality rates between children with intestinal failure-associated liver disease who received fish oil lipid emulsion (FOLE) or soybean oil intravenous lipid emulsion (SOLE). STUDY DESIGN: In this multicenter integrated analysis, FOLE recipients (1 g/kg/d) (n = 189) were compared with historical controls administered SOLE (≤3 g/kg/d) (n = 73). RESULTS: Compared with SOLE, FOLE recipients had a higher direct bilirubin level at baseline (5.8 mg/dL vs 3.0 mg/dL; P < .0001). Among FOLE recipients, 65% experienced cholestasis resolution vs 16% of SOLE recipients (P < .0001). The aspartate aminotransferase to platelet ratio index scores improved in FOLE recipients (1.235 vs 0.810 and 0.758, P < .02) but worsened in SOLE recipients (0.540 vs 2.564 and 2.098; P ≤ .0003) when baseline scores were compared with cholestasis resolution and end of study, respectively. Liver transplantation was reduced in FOLE vs SOLE (4% vs 12%; P = .0245). The probability of liver transplantation in relation to baseline direct or conjugated bilirubin (DB) was lower in FOLE vs SOLE recipients (1% vs 9% at DB of 2 mg/dL; 8% vs 35% at DB of 12.87 mg/dL; P = .0022 for both). Death rates were similar (FOLE vs SOLE: 10% vs 14% at DB of 2 mg/dL; 17% vs 23% at a DB of 12.87 mg/dL; P = .36 for both). CONCLUSIONS: FOLE recipients experienced a higher rate of cholestasis resolution, lower aspartate aminotransferase to platelet ratio index, and fewer liver transplants compared with SOLE. This study demonstrates that FOLE may be the preferred parenteral lipid emulsion in children with intestinal failure-associated liver disease when DB reaches 2 mg/dL. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00910104 and NCT00738101.
Authors: Muralidhar H Premkumar; Beth A Carter; Keli M Hawthorne; Kristi King; Steven A Abrams Journal: J Pediatr Date: 2012-11-16 Impact factor: 4.406
Authors: S Chan; K C McCowen; B R Bistrian; A Thibault; M Keane-Ellison; R A Forse; T Babineau; P Burke Journal: Surgery Date: 1999-07 Impact factor: 3.982
Authors: C Venturi; C Sempoux; J Bueno; J C Ferreres Pinas; C Bourdeaux; J Abarca-Quinones; J Rahier; R Reding Journal: Am J Transplant Date: 2012-08-06 Impact factor: 8.086
Authors: Daniel H Leung; Mahjabeen Khan; Charles G Minard; Danielle Guffey; Louise E Ramm; Andrew D Clouston; Gregory Miller; Peter J Lewindon; Ross W Shepherd; Grant A Ramm Journal: Hepatology Date: 2015-09-28 Impact factor: 17.425
Authors: Juan J Díaz; Kathleen M Gura; Juliamna Roda; Antonio R Perez-Atayde; Christopher Duggan; Tom Jaksic; Clifford W Lo Journal: J Pediatr Gastroenterol Nutr Date: 2013-09 Impact factor: 2.839
Authors: Vincent E de Meijer; Hau D Le; Jonathan A Meisel; Kathleen M Gura; Mark Puder Journal: J Pediatr Gastroenterol Nutr Date: 2010-02 Impact factor: 2.839
Authors: Alfonso Pastor-Clerigues; Ezequiel Marti-Bonmati; Javier Milara; Patricia Almudever; Julio Cortijo Journal: PLoS One Date: 2014-12-12 Impact factor: 3.240