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PubMedDate not supplied

Total parenteral nutrition--associated liver dysfunction.

We have reviewed all available data related to the development of liver dysfunction in patients receiving total parenteral nutrition (TPN). It seems that TPN-related liver dysfunction is multifactorial. Among all factors involved, two are most significant in the development of liver dysfunction, i.e. underlying disease and illness severity. In most cases, liver dysfunction is both self-limiting and reversible after cessation of TPN.

Cholestasis, Intrahepatic↗

PubMed1992

[Clinical examination of acetated Ringer solution in patients with normal liver function and those with liver dysfunction].

Acetated Ringer solution (AR) was studied clinically to find its usefulness in patients with liver dysfunction compared with lactated Ringer solution (LR). The thirty-eight patients scheduled to be operated were divided into four groups (Group I: with normal liver function and AR infused, Group II: with normal liver function and LR infused, Group III: with liver dysfunction and AR infused, Group IV: with liver dysfunction and LR infused). AR or LR was administered to each group at a speed of 10 ml.kg-1.h-1, and we investigated the differences of these four groups clinically. L-lactic acid increased significantly in all groups after administration of AR or LR. D-lactic acid increased in LR groups, and acetic acid increased in AR groups. However, the other parameters, including the acid-base balance, electrolytes and liver function, showed no significant changes in any group. Therefore the status of liver dysfunction did not affect the metabolism of lactic acid in this study. These findings indicate that as an intraoperative fluid, AR is just as useful as LR. However, there was no significant difference between the data of AR groups compared with those of LR groups. In conclusion, AR is not necessarily a better fluid compared with LR as an intraoperative fluid in patients with liver dysfunction.

Adult↗

PubMed2006

Recovery from liver dysfunction after adult isolated intestinal transplantation without liver grafting.

PURPOSE: We sought to evaluate liver function recovery after isolated intestinal transplantation in adults with irreversible intestinal failure. PATIENTS AND METHODS: Over a 5-year period, we transplanted 34 adult patients, 25 of whom received an isolated intestinal graft, 4 a multivisceral graft without a liver, and 5, a multivisceral graft with a liver. Among the group of patients transplanted with the isolated graft we selected 14 recipients with pretransplant liver dysfunction, namely, a serum bilirubin >2 mg/dL (normal value: 1.2) and/or transaminases >100 IU/mL (NV, 37/40). Other inclusion criteria were total parenteral nutrition, period > 3 months, no diagnosis of portal hypertension or cirrhosis. Two patients had biopsy-proven liver fibrosis. RESULTS: At discharge, all patients recovered liver function to normal values: mean bilirubin blood level was 0.9 +/- 0.96 mg/dL (range: 0.3-1.6) and mean transaminases were 26 +/- 9 and 31 +/- 18 IU/mL (range: 10-44/27-65). After a mean follow-up of 2 years, only one patient has an elevated alanine aminotransferase level without clinical signs of liver disease. Type of pretransplant liver disease did not impact on survival rates. CONCLUSION: In selected cases, an isolated intestinal or a multivisceral graft without a liver can represent a "liver salvage therapy" for an early failing liver in patients with irreversible intestinal failure. Pretransplant liver disease is not a negative prognostic factor.

Adult↗

PubMed1998

Early liver dysfunction in schistosomiasis.

BACKGROUND/AIMS: Liver dysfunction is said to occur only late in the course of schistosomiasis. As albumin levels tend to be normal, the observed prolonged prothrombin time is thought to arise from subclinical consumption coagulopathy. The aim of this study was to further evaluate this matter by studying the role of Schistosoma mansoni and liver function in the genesis of the compromised haemostasis tests in chronic "pure" schistosomiasis patients. METHODS: Twenty-five adults with chronic "pure" schistosomiasis were selected: 12 with the hepatointestinal form (group 2) and 13 with the compensated hepatosplenic form (group 3), as well as 10 matched control individuals (group 1). Alcoholism, viral hepatitis B and C, malnutrition (BMI<20 kg/m2), use of anticoagulant or anti-aggregant drugs and chronic diseases apart from schistosomiasis were carefully excluded. All patients were submitted to abdominal ultrasound and upper digestive endoscopy. Blood samples were used for routine hepatic tests and for transthyretin, prothrombin, antithrombin and protein C antigen determinations by immunodiffusion. Laboratory markers of coagulation activation (prothrombin fragment1+2(F1+2), serine esterases-antithrombin complexes (ATM) and plasminogen activator, tissue type activity (t-PA) were also assayed by ELISA and photometric determination, respectively. RESULTS: Decreased plasma levels of transthyretin (p<0.001), protein C (p:0.006), prothrombin (p:0.022) and antithrombin (p:0.008) contrasted with normal albuminaemia (p:0.094), F1+2 (p:0.061) and ATM (p:0.714) plasma levels in group 3 patients; t-PA activity (p:0.001) on the other hand, were increased in this group. CONCLUSIONS: These results suggest impairment of liver clearance and protein synthesis capacity rather than consumption coagulopathy. They also indicate that changes in liver function are not a late event in the course of schistosomiasis.

Adult↗

PubMed2005

The role of enteral nutrition in the reversal of parenteral nutrition-associated liver dysfunction in infants.

BACKGROUND: Liver dysfunction in children dependent on parenteral nutrition (PN) is well established, and the extent of hyperbilirubinemia has been shown to correlate with morbidity and mortality. The aim of this study was to assess whether increasing provisions of enteral nutrition can improve PN-associated hyperbilirubinemia over time. METHODS: A retrospective review was conducted on infants in our institution's Short Bowel Syndrome Clinic from 1999 to 2004. Inclusion criteria included PN duration more than 1 month, serum direct bilirubin more than 3 mg/dL while on PN, and tolerance of full enteral nutrition with eventual discontinuation of PN. Paired t tests were used for statistical analyses. RESULTS: Twelve infants were identified with a PN duration of 5 +/- 1 months. Five patients underwent liver biopsy while on PN, and histological evidence of cholestasis was found on all specimens. Peak total and direct bilirubin levels were 10.5 +/- 1.9 and 7.0 +/- 1.6 mg/dL, respectively, and occurred at time of PN discontinuation. Only 2 patients had improvement in serum bilirubin levels before initiation of full enteral nutrition. After initiation of full enteral nutrition and discontinuation of PN, all patients achieved permanent normalization of bilirubin levels by 4 months (P < .05) after a 1-month plateau phase. Alkaline phosphatase levels approached reference range within this time but were not significant. CONCLUSION: These data demonstrate for the first time that although PN-dependent infants can achieve normalization of marked hyperbilirubinemia with enteral nutrition, the improvement in liver function usually begins only after full enteral nutrition is tolerated and PN is withdrawn. These findings support the aggressive weaning of PN to enteral nutrition in infants with short bowel syndrome.

Alanine Transaminase↗

PubMedDate not supplied

Chronic liver dysfunction in multitransfused hemophiliacs.

Liver dysfunction and exposure to the hepatitis B antigen were assessed by serum transaminase (SGPT and SGOT) levels and HBsAg and anti-HBs during a three year period in a group of 118 patients with factor VIII or factor IX deficiency. The 107 HBsAg negative patients were divided into four groups according to their mode of therapy. Persistently abnormal transaminase values were present in 51 per cent of patients with a large exposure to factor VIII concentrates, in 43 per cent with a small factor VIII exposure and in 37 per cent exposed to prothrombin complexes. This was contrasted with abnormalities in 8 per cent of patients treated only with cryoprecipitate. The incidence and degree of serum transaminase abnormality appeared independent of a past history of jaundice. All patients without persistent antigenemia who had been treated with pooled plasma products showed antibodies to HBsAg. High titer anti-HBs prior to initial fraction therapy appeared protective against jaundice. The eleven patients with persistent antigenemia had significantly higher transaminase levels than the HBsAg negative group.

Alanine Transaminase↗

PubMed1997

Hepatitis C and G virus infection and liver dysfunction after allogeneic bone marrow transplantation: results from a prospective study.

Acute and chronic liver dysfunction is common after allogeneic bone marrow transplantation (BMT). Although toxicity, graft versus-host disease (GVHD), and viral infections are the major causes, etiologic diagnosis is difficult and often remains unknown. We conducted a prospective study to establish the role of the infection with both the hepatitis C virus (HCV) and the recently discovered hepatitis G virus (HGV) in liver dysfunction after BMT. From January 1994 to December 1995, 59 patients who had undergone an allogeneic BMT at our institution were enrolled in the study. HGV-RNA was identified in serum by nested polymerase chain reaction (PCR), and HCV was studied by the presence of second generation enzyme-linked immunosorbent assay (ELISA)-antibodies and HCV-RNA by nested PCR. HGV-RNA was detected in 25 patients (42%) (before BMT in 18 and after BMT in 7). HCV-RNA was present in 12 patients (20%) (before BMT in 11 and after BMT in one). The presence of HCV-RNA and HGV-RNA was clearly associated with a previous history of blood transfusions. No significant association was found between viral infection and acute liver toxicity. Some degree of liver dysfunction was present 6 months after BMT in 25 of 40 evaluable patients (62%). Long-term liver dysfunction was more common among patients infected with HCV alone (3 of 4) or with both HCV and HGV (3 of 3) than in those infected with either HGV alone (eight of 13) or with no virus infection (10 of 20). We found a high prevalence of HGV infection in our BMT population. However, no role for HGV in liver disease could be established in this study, and the relationship between HGV infection and liver dysfunction requires further clarification.

Acute Disease↗

PubMed2002

Liver dysfunction among workers handling 5-nitro-o-toluidine.

BACKGROUND: 5-Nitro-o-toluidine is an aromatic nitro amino compound. While other aromatic compounds are known to damage the human liver and are registered as toxic substances, toxicity information concerning 5-nitro-o-toluidine is lacking. AIMS: To investigate the hepatotoxicity of 5-nitro-o-toluidine. PATIENTS AND METHODS: Of 15 workers in the same factory who handled 5-nitro-o-toluidine, three were hospitalised with symptoms of acute liver dysfunction. Suspecting a link between liver dysfunction and working conditions, we correlated workplace factors with clinical findings in all 15 workers. RESULTS: Blood biochemistry tests indicated liver damage in seven of 15 study subjects. Workers who handled 5-nitro-o-toluidine and nitrosyl sulphuric acid often loosened their respiratory protective equipment shortly after 5-nitro-o-toluidine powder had been dispersed into the air of the room. No potential hepatotoxins were present except for 5-nitro-o-toluidine. Six of the affected workers had handled 5-nitro-o-toluidine 12 to 20 times; the seventh worker had handled the powder three times; and the other eight workers without liver dysfunction had handled the material once or twice. No other significant differences in background were evident between the affected and unaffected workers, such as age, sex, or protective measures. Histological findings during recovery from liver damage were similar to those of acute viral hepatitis. None of the 15 subjects has demonstrated liver damage since the factory was closed. CONCLUSIONS: A link between liver dysfunction and 5-nitro-o-toluidine exposure is suggested by greater severity of liver dysfunction associated with more episodes of handling.

Acute Disease↗

PubMed1997

[Cardiovascular surgery in the patients with liver dysfunction].

Under the current situations we have increasing opportunities to manage the patients with posthepatitis and/or congestive liver dysfunction. In order to prevent postoperative hepatic failure we described perioperative management for those patients. For this purpose, the major point is the selection of appropriate operative methods which reduce operative invasions and have sure efficacy. In order to decide operative methods, we have to grasp the functional reserve of dysfunctional liver. We have no effective methods to estimate the functional reserve, but our data suggested that serum cholinesterase level at the preoperative states might demonstrate prognostic significance. The others are managements of postoperative cardiopulmonary distress and infection. It goes without saying that preoperative improvement of anemia and poor nutrition.

Adolescent↗

PubMed1991

Relationship of HBsAg subtypes with HBeAg/anti-HBe status and chronic liver disease. Part II: Evaluation of epidemiological factors and suspected risk factors of liver dysfunction.

In this study, we examined a possibility that epidemiological factors or suspected risk factors of liver dysfunction could account for the different HBeAg/anti-HBe status or the different prevalence of liver dysfunction between the adr and adw carriers. A total of 428 HBsAg carriers were surveyed of their age, sex, racial background, socioeconomic status, place of residence, birthplace, alcohol consumption, smoking habit, and history of blood transfusion as epidemiological factors or suspected risk factors of liver dysfunction. Adjustment for those variables using multivariate analyses did not substantially affect the association of the HBsAg subtypes with either prevalence of liver dysfunction or HBeAg/anti-HBe status. HBsAg subtypes seem to directly affect HBeAg/anti-HBe status and consequently influence development of chronic liver disease.

Adult↗

PubMed2006

Liver dysfunction markedly decreases the inhibition of cytochrome P450 1A2-mediated theophylline metabolism by fluvoxamine.

BACKGROUND AND OBJECTIVES: In vivo inhibition of cytochrome P450 (CYP) 1A2 by fluvoxamine causes a reduction in the clearance of the high-extraction drug lidocaine, which decreases in proportion to the degree of liver dysfunction. The objectives of this study were (1) to evaluate the effect of liver cirrhosis on the inhibition by fluvoxamine of the metabolic disposition of theophylline, a CYP1A2 substrate with a low-extraction ratio, to assess whether decreased sensitivity to CYP1A2 inhibition in liver disease is a general characteristic of CYP1A2 substrates, regardless of their pharmacokinetic properties, and (2) to investigate the mechanism(s) underlying the effect of liver dysfunction on CYP1A2 inhibition. METHODS: The study was carried out in 10 healthy volunteers and 20 patients with cirrhosis, 10 with mild liver dysfunction (Child class A) and 10 with severe liver dysfunction (Child class C), according to a randomized, double-blind, 2-phase, crossover design. In one phase all participants received placebo for 7 days; in the other phase they received one 50-mg fluvoxamine dose for 2 days and two 50-mg fluvoxamine doses, 12 hours apart, in the next 5 days. On day 6, 4 mg/kg of theophylline was administered orally 1 hour after the morning fluvoxamine dose. Concentrations of theophylline and its metabolites, 3-methylxanthine, 1-methyluric acid, and 1,3-dimethyluric acid, were then measured in plasma and urine up to 48 hours. RESULTS: Fluvoxamine-induced inhibition of theophylline clearance decreased from 62% in healthy subjects to 52% and 12% in patients with mild cirrhosis and those with severe cirrhosis, respectively. CYP1A2-mediated formations of 3-methylxanthine and 1-methyluric acid were almost totally inhibited in control subjects, whereas they were only reduced by one third in patients with Child class C cirrhosis. Inhibition of 1,3-dimethyluric acid formation, which is catalyzed by CYP1A2 and CYP2E1, progressively decreased from 58% in healthy subjects to 43% and 7% in patients with mild cirrhosis and those with severe cirrhosis, respectively. CONCLUSIONS: The effect of liver dysfunction on the inhibition of CYP1A2-mediated drug elimination is a general phenomenon, independent of the pharmacokinetic characteristics of the CYP1A2 substrate. Therefore, for any drug metabolized by CYP1A2, the clinical consequences of enzyme inhibition are expected to become less and less important as liver function worsens. Two mechanisms, as follows in order of importance, are responsible for the effect of liver dysfunction: (1) decreased sensitivity to fluvoxamine of CYP1A2-mediated biotransformations in the cirrhotic liver, probably resulting from reduced uptake of the inhibitory drug, and (2) reduced hepatic expression of CYP1A2, which makes its contribution to overall drug elimination less important.

Adult↗

PubMed1982

Effect of antibiotics in the prevention of jejunoileal bypass-induced liver dysfunction.

Administration of antibiotics has been reported to prevent or minimize liver dysfunction in experimental animals having been subjected to jejunoileal bypass, suggesting that jejunoileal bypass-induced liver dysfunction results from production of toxic substances by bacteria in the defunctionalized bowel. However, improved absorption will also prevent bypass-induced liver injury. We studied the effects of tetracycline on the development of bypass-induced liver dysfunction and compared it to the mucosal adaptation of the intact bowel after bypass. After 6 weeks, rats subjected to bypass but not given antibiotics had decreased levels of serum triglycerides, hepatic cytochrome P-450, and hepatic pentobarbital hydroxylase. Evaluation of intestinal mucosal hyperplasia after bypass indicated that animals given antibiotics after bypass developed greater increases in mucosal DNA content, mucosal protein, and mucosal weight than bypassed animals not receiving antibiotics. We speculate that the beneficial effects of antibiotic administration on liver function after bypass may be a result of improved absorption.

Animals↗

PubMed1999

Levothyroxine-induced liver dysfunction in a primary hypothyroid patient.

Here we report a case of levothyroxine-induced liver dysfunction. T4 (levothyroxine) has been more commonly used for the treatment of hypothyroidism than T3 active hormone (triiodothyronine), because with the former drug a stabler plasma concentration is obtained after oral administration. Although there are few reports on levothyroxine-induced liver dysfunction, we treated a primary hypothyroid patient with high serum aminotransferase after administration of levothyroxine. Liver dysfunction was improved after cessation of the drug administration. Antibody to T4 was found in the serum of the patient after this event. From clinical course and laboratory data of the patient, the episode of liver damage was considered to be induced by levothyroxine. We then administrated triiodothyronine, and it did not induce liver dysfunction. Changing levothyroxine to triiodothyronine resulted in a successful clinical course in this case, as re-administration of the doubtful drug is strictly limited.

Adolescent↗

PubMed2006

C-reactive protein concentrations during bacteraemia: A comparison between patients with and without liver dysfunction.

OBJECTIVE: To evaluate the value of serum C-reactive protein (CRP) concentrations as a marker of sepsis in patients with biochemical evidence of liver dysfunction. DESIGN: A retrospective case-control comparison of serum CRP concentrations between patients with and those without liver dysfunction (prothrombin time over 18 s and serum bilirubin > or = 20 micromol/l) during their first episode of bacteraemia. SETTING: The neurosciences and general adult intensive care units of a university teaching hospital. PATIENTS: Any patient from the above settings with a first episode of bacteraemia (first isolate of pathogenic bacteria from blood cultures) over a 3-year period. MEASUREMENTS AND RESULTS: After exclusions 126 first episodes of bacteraemia were identified, of which 33 were in patients with liver dysfunction. Serum CRP concentrations were significantly lower in patients with liver dysfunction (median 103 mg/l, IQR 29-204) than in those without (146 mg/l, 74, > 250). CONCLUSIONS: Patients with biochemical evidence of liver disease generate significantly lower serum CRP concentrations during bacteraemia than patients without liver dysfunction. Serum CRP concentrations should be interpreted with caution in patients with liver disease to diagnose and monitor bacterial sepsis.

Adult↗

PubMed2005

Chemotherapy dosing in the setting of liver dysfunction.

Advanced cancer in the setting of liver dysfunction poses a dilemma for physicians, as many cancer chemotherapeutic agents undergo hepatic metabolism. Most cytotoxic drugs have a narrow therapeutic index, and the administration of chemotherapy to patients with liver impairment results in complicated safety issues. We present a concise review of cancer chemotherapy dosing in the setting of liver dysfunction. Although caution in treating all patients with hepatic failure is essential, the use of certain agents provokes greater concern than others. Continuous-infusion fluorouracil, capecitabine (Xeloda), mechlorethamine (Mustargen), cyclophosphamide, topotecan (Hycamtin), and oxaliplatin (Eloxatin) appear to be relatively well tolerated. On the contrary, taxanes, vinca alkaloids, irinotecan (Camptosar), and anthracyclines may cause unacceptable toxicity if administered to patients with poor hepatic function. For many anticancer agents, the paucity of data prohibits formal dosing recommendations, and most guidelines remain empiric.

Anthracyclines↗

PubMed1998

Liver dysfunction in patients with acute myelogenous leukemia: studies on patients not infected with hepatitis C virus during intense therapy.

Liver dysfunction often occurs during chemotherapy for AML, but the etiologies are many and varied. To determine liver dysfunction that is not related to HCV, liver function during intense therapy for one week after complete remission was studied in eight patients not infected with HCV (38 courses) and six HCV-infected patients (19 courses) with AML. There were remarkable differences in changes of ALT levels among HCV-infected patients. ALT level changes among patients not infected with HCV were similar. Changes in mean serum ALT levels in HCV-infected patients occurred at higher serum levels as compared with those in patients not infected with HCV. The mean serum ALT levels in patients not infected with HCV significantly increased at one week (45 +/- 5 IU/l) and further increased at two (58 +/- 8 IU/l) and three weeks (57 +/- 5 IU/l) as compared with pretreatment levels (24 +/- 21 IU/l) (p < 0.001, p < 0.001, p < 0.0001, respectively). ALT levels returned to normal at four weeks. During 31 of 38 courses (81.6%) in patients not infected with HCV, febrile episodes occurred at three weeks. The mean serum ALT levels in patients with febrile episodes were significantly higher than those in patients without febrile episodes at three weeks, and serum ALT levels at three weeks showed a significant positive correlation with CRP levels at three weeks. These findings indicate that liver dysfunction during chemotherapy for AML is due to hepatocellular injury, and infection or inflammatory cytokine induced by infection results in the worsening of the liver dysfunction.

Adult↗

PubMed2005

[Liver biopsy in the management of liver dysfunction after allogeneic hematopoietic stem-cell transplantation].

OBJECTIVE: To investigate the pathologic and clinical characteristics of patients with liver dysfunction after allogeneic hemopoietic stem cell transplantation (Allo-HSCT), and evaluate the role of liver biopsy in diagnosis and management of liver dysfunction post Allo-HSCT. METHODS: Ten patients with hematological diseases, 5 males and 5 females, aged 34.5 (15-56), underwent Allo-HSCT, 6 receiving Allo-HSCT from their HLA-matched siblings, one receiving haploidentical transplant, two receiving cord blood transplantation from sibling, and one receiving unrelated BMT. The conditioning regimens included Cy/TBI (in 2 cases), and non-TBI regimen (in 8 cases). All the patients received cyclosporine A, short term MTX and MMF for the prophylaxis of graft-versus-host disease (GVHD). Test of liver function and examination of HBV and HCV related serologic markers were performed for the patients and recipients before transplantation and for those who had liver dysfunction after transplantation. Percutaneous liver biopsy was performed for these 10 patients. Biopsy specimens were examined histologically by hematoxylin-eosin staining, Masson staining and immunohistochemical stating of related viruses. RESULTS: All 10 patients showed liver dysfunction on average 3.5 months (2-5 months) after the transplantation. Seven patients positive in HBV and HCV serologic markers before HSCT remained positive after the transplantation. Three patients negative in HBV/HCV markers before and after Allo-HSCT were diagnosed as with GVHD clinically. Eight patients had other manifestations of chronic GVHD. Eight patients received liver biopsy 5.5 months (4-12 months) because of poor improvement in the initial treatment stage. The result of biopsy showed hepatic GVHD in 3 patients and hepatic GVHD concomitant with HBV or HCV hepatitis reactivation in 7 patients. The liver function of 3 patients diagnosed as with hepatic GVHD returned to normal after the use of the second-line anti-GVHD therapy. The other 7 patients used anti-virus agents combined with immunosuppressive agents with the result that 2 patients remained alive with normal liver function and 5 patients died due to pulmonary complication (2 cases) or hepatic failure and hepatic coma (3 cases). CONCLUSION: Liver biopsy is of distinguished diagnostic value for patients with refractory hepatic GVHD after Allo-HSCT. The prognosis is poor for patients having hepatic GVHD concomitant with active hepatic virus infection. At this time the role of liver biopsy is limited and management should be made according to the clinical features and liver pathology.

Adolescent↗

PubMed2003

[Effect of painting work on alcoholic liver dysfunction].

The effect of painting on alcoholic liver dysfunction was investigated. The subjects were male workers engaged in small-scale enterprises under contract to with heavy industries. Painting involved metal cleaning and painting, and the air concentrations of organic solvents were frequently high. The study population consisted of 1,157 male workers over 40 yr of age. Of them, 85 were painters engaged for a mean duration of 20.9 +/- 9.8 yr. There was no significant difference in GOT and GPT between painters who did not drink and non-painters who did not drink, but GOT and GPT were significantly higher in painters drinking several days a week than in non-painters. A past history of hepatitis affected GOT, GPT and gamma-GTP. Painting, daily alcohol consumption, drinking frequency and body mass index affected gamma-GTP. A questionnaire survey of hepatitis was also conducted in 206 male workers (age range 18-67 yr). Of them, 134 were painters (mean duration of painting, 16.8 +/- 10.4 yr). This questionnaire survey showed that 13 painters (9.6% of the painters) and two non-painters (2.6% of the non-painters) had a history of hepatitis. Of the 13 painters, five painters had a history of hepatitis C and four had a history of alcoholic hepatitis. All of these 13 painters had the habit of drinking. This study indicated that painting had little effect on the liver function in painters not drinking, but increased alcoholic liver dysfunction in painters with the drinking habit.

Adolescent↗