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PEDIATRICS Vol. 103 No. 1 January 1999, pp. 52-57

Clinical and Genetic Risk Factors for Cystic Fibrosis-related Liver Disease

Received Mar 31, 1998; accepted Jul 23, 1998.

Michael Wilschanski*, Joseph RivlinDagger , Solomon Cohen*, Arieh Augarten§, Hannah Blauparallel , Micha Aviram, Lea Bentur#, Chaim Springer**, Yael VilaDagger Dagger , David Branski*, Batsheva Kerem§§, and Eitan Kerem*

From the * Department of Pediatrics, Cystic Fibrosis Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem; Dagger  Cystic Fibrosis Center, Carmel Medical Center, Haifa; § Cystic Fibrosis Center, Sheba Medical Center, Tel Hashomer; parallel  Cystic Fibrosis Center, Schneider Children's Medical Center, Petah Tikva;  Cystic Fibrosis Center, Soroka Medical Center, Ben Gurion University, Beer Sheba; # Cystic Fibrosis Center, Rambam Medical Center, Haifa; ** Cystic Fibrosis Center, Hadassah University Hospital, Jerusalem; Dagger Dagger  Department of Medical Statistics, Ichilov Medical Center, Tel Aviv; and §§ Department of Genetics, Life Sciences Institute, Hebrew University, Jerusalem, Israel.

Objective.  The aim of this study was to define the role of possible risk factors for the development of cystic fibrosis (CF)-related liver disease and to analyze the association between liver disease and the different genotypes present in the Israeli CF patient population.

Patients and Methods.  All patients followed at the seven CF centers in Israel were included in this study. Liver disease was determined by persistently elevated serum liver enzymes and/or bilirubin, and/or significant ultrasonographic changes suggestive of chronic liver disease. The following clinical parameters were evaluated: ethnic origin, age at assessment of liver function, sex, history of meconium ileus, pancreatic function, history of distal intestinal obstruction syndrome, pulmonary function, and cystic fibrosis transmembrane conductance regulator mutation analysis.

Results.  Of the 288 patients screened, 80 (28%) had liver disease. Of the 256 patients with pancreatic insufficiency, 80 (31%) had liver disease compared with none of the 32 patients with pancreatic sufficiency. Genotype-phenotype correlation was performed on 207 patients carrying identified mutations that were previously classified according to phenotype severity. Liver disease was found in 56 (32%) of 173 patients carrying mutations associated with a severe phenotype and in 6 (38%) of 16 patients carrying at least one mutation associated with a variable genotype (G85E and/or 5T allele). None of the 18 patients carrying the 3849+10kb C->T mutation had liver disease. Prevalence of liver disease increased with age. No correlation was found between liver disease and severity of lung disease, nutritional status, history of meconium ileus, or distal intestinal obstruction syndrome.

Conclusion.  CF patients who have pancreatic insufficiency and carry mutations associated with a severe or a variable genotype are at increased risk to develop liver disease.  Key words:  cystic fibrosis, liver disease, phenotype, genotype, risk factors.


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