Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2015; 21(17): 5115-5118
Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5115
Review on hepatic explant pathology of pediatric intestinal transplant recipients: Is it time for an oil change?
Essam Imseis, J Marc Rhoads
Essam Imseis, J Marc Rhoads, Department of Pediatrics, Divisions of Gastroenterology and Hepatology, University of Texas Medical School at Houston, Houston, TX 77030, United States
Author contributions: Imseis E and Rhoads JM contributed equally to the editorial writing in this manuscript.
Conflict-of-interest: There are no conflicts of interest for either of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: J Marc Rhoads, Department of Pediatrics, Divisions of Gastroenterology and Hepatology, University of Texas Medical School at Houston, 6431 Fannin St., MSB 3.137, Houston, TX 77030, United States. j.marc.rhoads@uth.tmc.edu
Telephone: +1-713-5007642 Fax: +1-713-5005750
Received: October 16, 2014
Peer-review started: October 16, 2014
First decision: November 14, 2014
Revised: February 10, 2015
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: May 7, 2015
Processing time: 209 Days and 5 Hours
Abstract

A recent study attempts to add to the body of evidence that is emerging regarding the fish oil parenteral lipid product Omegaven™. The authors have shown from explant livers of children on chronic parenteral nutrition with Omegaven™ that biochemical improvement in cholestasis does not always reflect improvement in liver histology. These findings support 2 small case series that were previously published. Despite improvement and resolution of hyperbilirubinemia in all six infants, five of six infants had persistent or progressive hepatic fibrosis, while only one infant had regression of fibrosis. The study raises questions of whether there is a window of opportunity for efficacy of this preparation; also, an important question is if this omega-3 fatty acid-rich preparation is superior to newer “blended lipids” containing olive, coconut, soy, and fish oil.

Keywords: Intralipid; Omegaven; Parenteral nutrition; Short bowel syndrome; Omega-3 fatty acid

Core tip: Short bowel syndrome in infants frequently leads to intestinal failure. The use of soybean-based parenteral lipids allowed a major increase in parenteral calories but its use has been associated with development of severe liver disease. In the study by Matsumoto et al, six infants with liver failure secondary to parenteral nutrition experienced improvement and resolution of hyperbilirubinemia in response to a fish oil preparation, but when they came to liver/intestinal transplantation, 5 had persistent or worsening hepatic fibrosis. There may be other, better alternatives to Omegaven™.