Hepatic explant pathology of pediatric intestinal transplant recipients previously treated with omega-3 fatty acid lipid emulsion

J Pediatr. 2014 Jul;165(1):59-64. doi: 10.1016/j.jpeds.2014.03.034. Epub 2014 May 3.


Objective: To evaluate and compare the biochemical and histologic effect of parenteral fish oil lipid emulsion that is rich in omega-3 polyunsaturated fatty acids (O3FAs), Omegaven (Fresenius Kabi AG, Bad Homburg, Germany) with standard omega-6 polyunsaturated fatty acid (O6FA) parenteral nutrition.

Study design: Comparison of hepatic explant pathology and biochemical outcome on pediatric patients with intestinal failure treated with either parental O3FA or O6FA who had received a liver-inclusive intestine transplant.

Results: Seven liver-inclusive intestinal transplants were performed in 7 patients who received O3FA for a mean of 62% ± 13% of total patient life-span (16.1 ± 7.0 months) before transplant. Median total bilirubin fell from 6.9 mg/dL at the start of treatment to 0.7 mg/dL at the time transplant (P < .02), which was a significant decrease compared with the similarly matched O6FA cohort (P = .012). All 7 of the 03FA-treated patients received a liver-inclusive intestinal transplant had advanced fibrosis (stage 3 or 4) noted on explant pathologic examination, despite a resolution of cholestasis at the time of transplant. Histologic inflammatory scores were lower (P = .056) in the 03FA group with similar degrees of advanced fibrosis as in the O6FA group.

Conclusions: In a matched comparison of patients undergoing intestinal transplantation with a history of extended O3FA lipid emulsion therapy that successfully reversed hyperbilirubinemia, significant hepatic fibrosis was present in the explanted livers despite a reduction in inflammation. This result confirms concern that the use of O3FA may have a limited role in altering the development of hepatic fibrosis from parenteral nutrition.

MeSH terms

  • Bilirubin / blood
  • Child, Preschool
  • Fat Emulsions, Intravenous*
  • Fatty Acids, Omega-6 / administration & dosage
  • Fatty Acids, Omega-6 / therapeutic use
  • Female
  • Fish Oils / administration & dosage*
  • Fish Oils / therapeutic use
  • Humans
  • Hyperbilirubinemia / therapy*
  • Intestinal Diseases / complications
  • Intestinal Diseases / surgery
  • Intestinal Diseases / therapy*
  • Intestines / transplantation*
  • Liver / pathology*
  • Liver Cirrhosis / diagnosis*
  • Liver Function Tests
  • Liver Transplantation
  • Male
  • Treatment Outcome
  • Triglycerides


  • Fat Emulsions, Intravenous
  • Fatty Acids, Omega-6
  • Fish Oils
  • Triglycerides
  • fish oil triglycerides
  • Bilirubin