PMID- 19524721
OWN - NLM
STAT- MEDLINE
DCOM- 20090902
LR  - 20211020
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Print)
IS  - 0022-3468 (Linking)
VI  - 44
IP  - 6
DP  - 2009 Jun
TI  - Persistent alanine aminotransferase elevations in children with parenteral 
      nutrition-associated liver disease.
PG  - 1084-7; discussion 1087-8
LID - 10.1016/j.jpedsurg.2009.02.011 [doi]
AB  - BACKGROUND: Parenteral nutrition-associated liver disease (PNALD) is a serious 
      condition affecting many children with short bowel syndrome. The aim of this 
      study was to longitudinally assess serum alanine aminotransferase (ALT), a marker 
      for hepatocyte injury, in enterally fed children with PNALD. METHODS: 
      Retrospective chart review of 31 patients treated from 1999 to 2006 by the Center 
      for Advanced Intestinal Rehabilitation at Children's Hospital Boston (Mass). 
      Inclusion criteria included PN duration of greater than 3 months with subsequent 
      tolerance of full enteral nutrition and evidence of PN-associated liver injury. 
      Time to normalize ALT and direct bilirubin were estimated using Kaplan-Meier and 
      Cox proportional hazards methods. RESULTS: Mean age PN cessation was 6 months 
      (range, 2-14 months). Median PN duration was 18 weeks (interquartile range [IQR], 
      13-33 weeks), and median follow-up was 24 weeks (IQR, 14-48 weeks). After 
      transition to full enteral nutrition, 74% of children normalized direct 
      bilirubin, whereas only 50% normalized ALT. Kaplan-Meier median time to direct 
      bilirubin and ALT normalization were 13 weeks and 35 weeks, respectively (P = 
      .001). CONCLUSION: Children with PNALD who have achieved PN independence have 
      persistent ALT elevation despite normal direct bilirubin levels. This implies 
      that hepatic injury may be ongoing beyond the time of bilirubin normalization in 
      this cohort of patients.
FAU - Yang, Chi-Fu Jeffrey
AU  - Yang CF
AD  - Harvard Medical School, Boston, MA 02115, USA.
FAU - Lee, Michele
AU  - Lee M
FAU - Valim, Clarissa
AU  - Valim C
FAU - Hull, Melissa A
AU  - Hull MA
FAU - Zhou, Jing
AU  - Zhou J
FAU - Jones, Brian A
AU  - Jones BA
FAU - Gura, Kathy
AU  - Gura K
FAU - Collier, Sharon
AU  - Collier S
FAU - Lo, Clifford
AU  - Lo C
FAU - Duggan, Christopher
AU  - Duggan C
FAU - Jaksic, Tom
AU  - Jaksic T
LA  - eng
GR  - P30 DK040561/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
RN  - 0 (Biomarkers)
RN  - EC 2.6.1.2 (Alanine Transaminase)
SB  - IM
MH  - Alanine Transaminase/*blood
MH  - Biomarkers/blood
MH  - Enteral Nutrition
MH  - Female
MH  - Humans
MH  - Infant
MH  - Liver Diseases/*blood/etiology
MH  - Male
MH  - Parenteral Nutrition/*adverse effects
MH  - Retrospective Studies
MH  - Short Bowel Syndrome/etiology/therapy
PMC - PMC4547788
MID - NIHMS714065
EDAT- 2009/06/16 09:00
MHDA- 2009/09/03 06:00
PMCR- 2015/08/24
CRDT- 2009/06/16 09:00
PHST- 2009/02/05 00:00 [received]
PHST- 2009/02/17 00:00 [accepted]
PHST- 2009/06/16 09:00 [entrez]
PHST- 2009/06/16 09:00 [pubmed]
PHST- 2009/09/03 06:00 [medline]
PHST- 2015/08/24 00:00 [pmc-release]
AID - S0022-3468(09)00159-6 [pii]
AID - 10.1016/j.jpedsurg.2009.02.011 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2009 Jun;44(6):1084-7; discussion 1087-8. doi: 
      10.1016/j.jpedsurg.2009.02.011.