Preservation of liver function in intestinal failure patients treated with long-term total parenteral nutrition

PURPOSE OF REVIEW: The purpose of this article is to review the diagnosis, prevalence, pathophysiology, and treatment of parenteral nutrition-associated liver disease. RECENT FINDINGS: Parenteral nutrition-associated liver disease is more prevalent in adults than once thought. Malabsorption of nutrients such as choline and altered metabolism of intravenously infused nutrients play an important role in its development. SUMMARY: Parenteral nutrition can be a life-saving therapy for patients with short bowel syndrome; however, its long-term use can be limited by hepatic complications. The degree of liver injury can range from a mild, reversible elevation in liver function tests to end-stage liver disease. The pathophysiology underlying this complication remains unclear although it is almost certainly multifactorial in origin. Although conservative measures have a role in management, they are often ineffective once advanced liver disease has developed. Intestinal transplant should be addressed early in the course of disease, at a point in which the liver injury may be reversible. Once cirrhosis has developed, combined liver/intestinal transplant may be the only option.