Parenteral nutrition-associated liver disease in children

Liver disease is a frequent complication in patients treated by parenteral nutrition. Recent data showed that it occurs not only in children but also in adults. The pathogenesis is multifactorial, gut factors being far more important than nutritional ones in determining it. The recurrence of sepsis, the length of the intestinal remnant after surgery, the lack of enteral feeding are supposed to be strongly correlated to the occurrence of hepatic damage. The recognition of risk factors and the plan for preventive measures are the goals in treating such patients. Recent data have demonstrated that the care for nutritional status and for intestine is crucial in reducing the risk of progressive hepatic damage. The availability of intestinal transplantation poses new questions in dealing with such patients and requires a strict prevention of parenteral nutrition-associated complications, in order to eventually improve the outcome of transplantation candidates.