Arch Pathol Lab Med 1981 Mar;105(3):152-6

Pediatric total parenteral nutrition. Liver histopathology

Cohen C, Olsen MM

Abstract
Correlation of clinical data with hepatic histopathology from 31 infants
receiving total parenteral nutrition (TPN) suggest chronologic progression of
liver disease with long-term TPN. Steatosis and a prominent eosinophil component
in portal-tract extramedullary hematopoiesis appear during the first five days
of TPN. The former persists for 90 days, the latter for three weeks. Canalicular
cholestasis was present after ten days in 84.2% of the livers studied and bile
duct proliferation in 63.6% after three weeks of TPN. Moderate to severe portal
fibrosis only occurred after 90 days, whereas micronodular cirrhosis developed
in one patient after five months of TPN. Lipofuscin-like pigment and hemosiderin
were each demonstrated in 90.3% of the livers studied. Our findings suggest that
with up to 90 days of TPN most changes should either be reversible or not severe
enough to result in liver failure.