Cyclic Total Parenteral Nutrition Decreases Conjugated Bilirubin in Adult Patients with Parenteral Nutrition-Associated Liver Disease

Purpose: Parenteral nutrition-associated liver disease (PNALD) is one of the most common complications of total parenteral nutrition (TPN). The adjustment from continuous TPN (24TPN) to cyclic TPN (cTPN) provides the liver with a time of metabolic rest, which may facilitate recovery from PNALD. The purpose of this study was to evaluate the effects of cTPN on liver function of patients with PNALD. Materials and methods: A retrospective study was carried out at a medical center in Taiwan between January 2014 and March 2016. Inpatients who were ≥18 years old, prescribed TPN for ＞7 days, and demonstrated impaired liver function were enrolled. Serum hepatic biochemical parameters were measured at baseline, the start of TPN, the end of TPN, and before discharge, and compared. Results: Among the 56 patients enrolled, 28 (50%) were on cTPN following elevation of total (median 1.9 to 6.2, p=0.010), direct (median 1.2to 3.4, p=0.036), and indirect bilirubin (median 0.8 to 2.2, p=0.013). Total (median 4.4, p=0.014) and direct bilirubin (median 2.9, p=0.022) recovered after cTPN intervention. Such recovery was not observed in 24TPN group. Conclusions: Administration of cTPN is effective for treating PNALD, especially in terms of direct bilirubin recovery.