Neonatal hemochromatosis--medical treatment vs. transplantation: the king's experience.

Abstract

The aim of our study was to compare the outcome of medical treatment vs. liver transplantation in infants with neonatal hemochromatosis (NH) referred to King's College Hospital from 1990-2002. We conducted a retrospective review of 19 children from 14 families. Fifteen children presented at birth and 4 during the first week of life. One child was diagnosed by cordocentesis at 30 weeks of gestation. NH recurred in 7 of 9 families with further children. In one family, 2 children from different fathers were affected. All patients had elevated ferritin levels, hypoalbuminemia, and coagulopathy. Liver histology showed parenchymal collapse, diffuse fibrosis, and moderate to severe hepatocyte hemosiderin deposition. Extrahepatic siderosis was demonstrated by magnetic resonance in 2 patients, lip biopsy in 3, and autopsy in 10. Ten patients received a chelation-antioxidant cocktail: 1 survived, 4 died, and 5 required liver transplantation, of whom 2 died. One of the 9 infants who did not receive the cocktail survived with medical support, 3 died, and 5 required transplantation, of whom 3 died. Seven children are alive, 5 after transplantation, at a median follow-up of 5.6 years, with excellent quality of life and no recurrence of the disease. In conclusion, chelation-antioxidant treatment does not appear to modify the prognosis of NH, at least in severe cases. Liver transplantation, with 50% long-term survival, remains the treatment of choice and should be promptly offered to those infants who do not improve with supportive medical treatment.

• Authors: Fernanda Rodrigues, Marcia Kallas, Ruth Nash, Paul Cheeseman, Lorenzo D'Antiga, Mohamed Rela, Nigel D Heaton, Giorgina Mieli-Vergani
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 11 Issue 11 Pg. 1417-24 (Nov 2005) ISSN: 1527-6465 [Print] United States
• PMID: 16237701 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antioxidants
• Chelating Agents

Topics

• Antioxidants (therapeutic use)
• Chelating Agents (therapeutic use)
• Cohort Studies
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Hemochromatosis (diagnosis, drug therapy, mortality, surgery)
• Humans
• Infant, Newborn
• Infant, Newborn, Diseases (diagnosis, drug therapy, mortality, surgery)
• Liver Transplantation (adverse effects, methods)
• Male
• Probability
• Retrospective Studies
• Risk Assessment
• Sensitivity and Specificity
• Severity of Illness Index
• Statistics, Nonparametric
• Survival Analysis
• Treatment Outcome
• United Kingdom