Fiel M Isabel, Wu Hai-Shan, Iyer Kishore, Rodriguez-Laiz Gonzalo, Schiano Thomas D
Lillian and Henry M Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, NY 10029, USA.
J Gastrointest Surg. 2009 Sep;13(9):1717-23. doi: 10.1007/s11605-009-0914-7. Epub 2009 May 6.
Liver disease and the development of hepatic fibrosis are complications associated with total parenteral nutrition (TPN). Patients developing cirrhosis and portal hypertension in the setting of intestinal failure have a high mortality and may require combined liver and intestinal transplantation which carries much higher morbidity and mortality than isolated intestinal transplantation.
Recently, regression of hepatic fibrosis in patients with TPN liver disease has been described following intestinal transplantation. To date, there has been no demonstration of the reversal of established cirrhosis due to long-term TPN injury. Herein, we describe a patient with intestinal failure who developed cirrhosis from long-standing TPN injury and underwent isolated intestinal transplantation. He had no overt clinical stigmata of portal hypertension and had preserved liver function. Serial liver biopsies were reviewed and assessed with standard histology and quantitation of fibrosis using image analysis. Dramatic regression of fibrosis and reversal of cirrhosis were observed 17 months posttransplantation. Image analysis demonstrated a 14% total decrease in the percentage area of fibrosis.
Cirrhosis related to TPN may be rapidly reversible after isolated intestinal transplantation. Such patients may be able to undergo isolated intestinal transplantation if they do not have hepatic synthetic compromise or clinical stigmata of portal hypertension.
肝病和肝纤维化的发展是全胃肠外营养（TPN）相关的并发症。在肠衰竭情况下发展为肝硬化和门静脉高压的患者死亡率很高，可能需要联合肝肠移植，这比单纯肠移植的发病率和死亡率要高得多。
最近，有报道称肠移植后TPN肝病患者的肝纤维化有所消退。迄今为止，尚未有因长期TPN损伤导致的已确立肝硬化逆转的例证。在此，我们描述了一名肠衰竭患者，他因长期TPN损伤发展为肝硬化并接受了单纯肠移植。他没有门静脉高压的明显临床体征，肝功能保持良好。对系列肝活检标本进行了回顾，并采用标准组织学和图像分析对纤维化进行定量评估。移植后17个月观察到纤维化显著消退和肝硬化逆转。图像分析显示纤维化面积百分比总共下降了14%。
与TPN相关的肝硬化在单纯肠移植后可能迅速逆转。如果此类患者没有肝合成功能受损或门静脉高压的临床体征，他们可能能够接受单纯肠移植。
