OC63 The use of omegaven rescue therapy (ORT) in the treatment of intestinal failure associated liver disease (IFALD) in patients already received SMOF lipid: a tertiary single centre experience

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The role of lipid manipulations in parenteral nutrition (PN) in changing the natural history of IFALD is well established. European centres report utilising a mixed lipid formula ‘SMOF’ (Soy, Medium chain (coconut), Olive and Fish) for prevention and treatment of IFALD, with North American centres using a pure fish oil ‘Omegaven’ in established IFALD.1Whilst there has been a suggestion that the use of Omegaven may have additional benefit for ‘rescue therapy’ for patients on SMOF lipid who have still developed IFALD.2 either with cholestasis or deterioration of LFTs, to date there are limited published ‘real world’ cross-over data. We report our use of Omegaven rescue therapy (ORT) in paediatric Intestinal Failure (IF). Since Jan 2019, under the advice of the specialist nutrition team, ORT was used selectively in the apriori agreed context of: IF, continued evidence of worsening liver function (total bilirubin (Tbil) >20umol/l or x3 rise in ALT/AST) despite anti-sepsis measures and prior lipid reduction to 1g/kg/day. Omegaven was given at 1–1.5g/kg/day. Data from Jan 2019- Dec 2022 was gathered including: demographics, sepsis, serial change in Tbil, Conjugated bilirubin, AST/ALT, with trend analyses over multiple time points with date of commencement ORT was performed using Dunnett multiple comparisons with control (CI 95% p<0.05). Exclusions to analyses included: inadequate rise in LFTs/Tbil, death during Rx and additional liver diagnoses. 15 included patients (8 in NICU) received ORT. ORT was given for 7–33 days. Median Tbil levels were rising significantly prior to ORT and then fell significantly both at T+14 days and T+28 days. (Figure 1). ALT/AST fell in the group but was not statistically significant. Including retreatments in individual patients also reduced treatment effect. We present provisional data of ORT in patients already established on SMOF and lipid lowering strategies. We see that the most common indication for Omegaven is rising liver function tests both in context of sepsis/suspected sepsis and longstanding IFALD. We observed a rapid significant fall in Tbil with 14 days of therapy, despite a significantly rising Tbil prior to initiation. These data could be improved by additional cases, and defining a contemporary control group that are well matched for IF co-morbidity, age and deteriorating liver function however they differ to the natural history of IFALD. The possibility for a more sustained switch to Omegaven in a very select group of IF patients with longstanding deteriorating liver function merits exploration, as does the use of ORT in IF patients at risk of liver dysfunction during sepsis episodes. References Barclay AR, Henderson P. J Pediatr Gastroenterol Nutr 2016;62(3):363–4. ESPGHAN; Lapillonme A, et al. Clin Nutr 2018;37:2324–36.

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