{
  "abstract": "Biliary atresia remains the most common cause of paediatric end-stage liver disease and the leading indication of liver transplantation in children. Despite early Kasai portoenterostomy, some children progressed to cholestatic liver failure, nutritional compromise and ascites. Severe malnutrition in this group worsens transplant outcomes and long waiting time for the graft. Enteral feeding is frequently limited by intolerance, gastrointestinal bleeding or marked ascites. Parenteral nutrition, therefore, becomes an essential bridge to stabilise nutritional status before transplantation. However, data on its practical use, duration and complications in biliary Atresia patients with end-stage liver disease remain sparse. This review describes our experience with parenteral nutrition in this unique population.To describe the indications, duration and outcomes of parenteral nutrition in children with Biliary atresia and end-stage liver disease in a single paediatric liver centreWe performed a retrospective review of all children with biliary atresia and end-stage liver disease who received PN at our centre within 5 years. Demographics, indication and duration of parenteral nutrition, transplant status, biochemical profile and parenteral nutrition-related complications were extracted from the electronic record. Continuous data are expressed as medians (with interquartile ranges, IQRs), and categorical data are presented as numbers and percentages (%).Sixteen children with biliary atresia received parenteral nutrition. Fifteen (93.8%) were infants, median age at parenteral nutrition initiation of 7 months (IQR 6-8): one child, aged 6 years had hepatopulmonary syndrome secondary to biliary atresia-related complications. All 16 patients received parenteral nutrition due to nutritional compromise. At baseline, the median (interquartile range) weight was 6.4 kg (5.8-6.9): the corresponding biochemical parameters were bilirubin 319 umol/L (192-386) albumin 25 g/L (22-28); INR 1.5 ( 1.2-1.65) and median parenteral nutrition duration before transplant was 35 days (IQR 23-75); while the pretransplant median (interquartile range) parameters were; weight 6.24 kg (6.04-8.14), bilirubin 241 umol/L (122-302), albumin 26 g/L (24-28), INR 1.55 ( 1.3-1.8). Most children required short-term parenteral nutrition (<6weeks), although one child with complex bowel obstruction remained parenteral nutrition-dependent for approximately two years.Fourteen children (87.5%) proceeded to liver transplantation and survived; two (12.5%) died while on the transplant waiting list. Of those transplanted, all survived to discharge. Post-transplant recovery was generally favourable; most resumed full enteral feeds within 2-3 weeks. There was no significant deterioration in the cholestatic parameters, and a single case of line-related sepsis (6%) was treated with meropenem.Our study showed that short term parenteral nutrition aided nutritional recovery and decreased morbidity related malnutrition without major complication. As wait time for graft is significantly increasing, nutritional stabilisation is important while awaiting a definite treatment of liver transplant. Further multicentre studies are needed to define the optimal timing, duration, and criteria for the use of parenteral nutrition, as well as its impact on transplant readiness and long-term outcomes.References Sullivan JS, Sundaram SS, Pan Z. Parenteral nutrition supplementation in biliary atresia patients listed for liver transplantation. Liver Transpl 2012 Jan;18(1):120–8.Choe U. Nutritional management for peadiatric biliary atresia patients preparing for liver transplantation. Children 2025 Mar 20;12(3):391.",
  "authors": [
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS trust"
      ],
      "name": "Opeyemi Akinmadelo"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS trust"
      ],
      "name": "Nwaduito Ofor"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS trust"
      ],
      "name": "Sanjay Rajwal"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS trust"
      ],
      "name": "Palaniswamy Karthikeyan"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS trust"
      ],
      "name": "Marumbo Mtegha"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS trust"
      ],
      "name": "Kavitha Jayaprakash"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS trust"
      ],
      "name": "Penny North-Lewis"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospital NHS trust"
      ],
      "name": "Kirsten Tremlett"
    }
  ],
  "title": "OC33 Parenteral nutrition in children with biliary atresia and end-stage liver disease: a descriptive retrospective review from a single paediatric liver centre",
  "uid": "e3859614-681f-5fd7-9f3e-1361548fbf37"
}