Growth dependent survival in cholestatic infants listed for liver transplantation

Background: Liver transplantation has become the standard therapy for children with end stage cholestatic liver disease (ESCLD). More than half of all pediatric liver transplantations are performed in infants younger than 24 months. Although long-term survival rate after transplantation exceeds 80%, mortality is high in those awaiting liver transplantation. Infants with ESCLD are severely jaundiced, have portal hypertension leading to ascites, hypersplenism and risk of esophageal variceal bleeding, and may develop life-threatening systemic infections. Maintaining adequate growth under these circumstances is a challenging objective. We aimed to identify predictors of death in infants with ESCLD awaiting liver transplantation and included the impact of growth failure. Methods: In this single center study we collected data of all infants with ESCLD who were listed for a first transplant before the age of 24 months. Primary outcome was death before transplantation. Multivariate logistic regression analysis was used to identify factors associated with pre-transplantation mortality. Results: Between January 2000 and December 2010 a total of 62 consecutive infants with ESCLD were included. Biliary atresia was diagnosed in 94%. Thirteen infants (21%) died while awaiting transplantation. Significant predictors at the time of listing were total serum bilirubin, blood type B (Odds ratio (OR) 17.78; 95%CI 1.94-163.32) and primary listing without hepatoportoenterostomy (HPE) (OR 17.16; 95%CI 1.87-157.43). In infants who were not transplanted within the first three months after listing, growth failure was a significant predictor of death before transplantation (OR 51.17; 95%CI 1.07-2444.50), next to total serum bilirubin. Conclusions: Significant predictors of waiting list mortality in the Netherlands included high total serum bilirubin, blood type B and primary listing without HPE. In infants not transplanted within 3 months after listing growth failure is of significant importance. Early transplantation with a living related donor organ, or early aggressive nutritional intervention to maintain growth could help to improve the outcome of infants with ESCLD.

Biomarkers and non-invasive tests for gastrointestinal mucositis

Item does not contain fulltextGastrointestinal mucositis is a complex inflammatory reaction of the mucous membranes, a side effect of both chemotherapy and radiotherapy. Currently, assessment scales are used to diagnose mucositis. However, a biomarker which would determine whether there is mucositis and thereby establish the severity objectively would be very useful. This will give the opportunity to evaluate studies, to determine risk factors and incidence, and it will make it possible to compare studies. Moreover, this biomarker might improve clinical management for patients. In this paper, we reviewed studies concerning potential biomarkers in blood samples and fecal samples, and potential tests in breath samples and urine samples. We include biomarkers and tests studied in animal models and/or in clinical trials, and discuss the validity, diagnostic accuracy, and applicability

Tumor Necrosis Factor-Alpha Inhibitor Etanercept Does Not Alter Methotrexate-Induced Gastrointestinal Mucositis in Rats

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