https://pubmed.ncbi.nlm.nih.gov/33038344/

J Pediatr. 2020 Oct 7;S0022-3476(20)31260-9.
doi: 10.1016/j.jpeds.2020.09.068.Online ahead of print.

Fish Oil Emulsion Reduces Liver Injury and Liver transplantation in Children with Intestinal Failure-Associated Liver Disease: A Multicenter Integrated Study

Kathleen M Gura 1, Muralidhar H Premkumar 2, Kara L Calkins 3, Mark Puder

Objective: To compare aminotransferase with platelet ratio index (APRI), liver transplantation, and mortality rates between children with intestinal failure-associated liver disease (IFALD) who received fish oil lipid emulsion (FOLE) or soybean oil lipid emulsion (SOLE).

Study design: In this multicenter integrated analysis, FOLE recipients (1 g/kg/d) (n=189) were compared with historical controls administered SOLE (up to 3 g/kg/d) (n=73).

Results: Compared with SOLE, FOLE recipients had a higher direct bilirubin level at baseline (5.8 vs. 3.0 mg/dL, P < .0001). Among FOLE recipients, 65% experienced cholestasis resolution vs. 16% of SOLE (P<0.0001). APRI scores improved in FOLE (1.235 vs. 0.810 and 0.758, P<0.02) but worsened in SOLE recipients (0.540 vs. 2.564 and 2.098, P≤0.0003) when baseline scores were compared with cholestasis resolution and end of study, respectively. Liver transplantation was reduced in FOLE vs. SOLE (4% vs. 12%, P=0.0245). The probability of liver transplantation in relation to baseline DB was lower in FOLE vs SOLE recipients (1% vs. 9% at DB of 2 mg/dL; 8% vs 35% at DB of 12.87 mg/dL, P=0.0022 for both). Death rates were similar (FOLE vs. SOLE: 10% vs. 14% at DB of 2 mg/dL; 17% vs. 23% at a DB of 12.87 mg/dL, P=0.36 for both).

Conclusion: FOLE recipients experienced a higher rate of cholestasis resolution, lower APRI, and fewer liver transplants compared with SOLE. This demonstrates that FOLE may be the preferred parenteral lipid emulsion in children with IFALD when DB reaches 2 mg/dL. Trial registration Clinicaltrials.gov: NCT00910104 and NCT00738101.