Does cyclosporin A worsen liver function in patients with inflammatory bowel disease and total parenteral nutrition?

OBJECTIVE: inflammatory bowel disease (IBD), total pa renteral nutrition (T PN) and immunosuppressive treatment with cyclosporin A (CsA) are well known factors in hepatobiliary disorders. Their association, however, has been l ittle studied, METHOD: we retrospectively analyzed the results of liver function tests (tr ansaminases, AST. ALT), total bilirubin, alkaline phosphatase, and gamma-gl utamyltransferase (GGT) in a consecutive series of 50 patients (29 men, 21 women, mean age 32 years, range 16-78 years) hospitalized for a severe atta ck of IBD between January 1992 and July 1997. Basal laboratory values in al l patients were normal. Thirty-eight patients had ulcerative colitis (UC) a nd 12 had Crohn's disease (CD), which debuted in 28% of the patients. All p atients were treated with methylprednisolone (MP) (0.75-1.0 mg/kg daily i.v ., and received TPN. 42% (21/50) required additional treatment with CsA (5 mg/kg daily i.v.) at the beginning or during the first week of TPN and duri ng 7-24 days, because on nonresponse to steroid treatment. Two study groups were defined according to treatment: Group I consisted of 29 patients give n MP + TPN, and group II comprised 21 patients who received MP + TPN + CsA. The groups were otherwise similar in all other variables analyzed, Liver f unction tests were done weekly until the end of the study period. RESULTS: 62% of the patients (31/50) showed hepatobiliary dysfunction, defi ned previously as a 2-fold or greater elevation of two or more parameters. There was no statistically significant difference between the two groups in the incidence of dysfunction (15/29 vs 16/21, n.s.), The parameters that s howed the greatest alterations were GGT and ALT; the greatest elevation app eared during the third week of immunosuppressive treatment, and did not exc eed 6-fold the normal value. The alterations disappeared once TPN and immun osuppressive treatment were discontinued, CONCLUSIONS: the hepatobiliary dysfunction in patients treated with both TP N and CsA was no more severe than associated with TPN alone.