Alpha1-antitrypsin deficiency: Transition of care for the child with aat deficiency into adulthood

Henry Lin, Nagraj Kasi, J. Antonio Quiros

Research output: Contribution to journalArticle

Abstract

Importance: Alpha1-antitrypsin (AAT) deficiency is a common, but an underdiagnosed genetic condition, affecting 1 in 1500 individuals. It can present insidiously with liver disease in children. Although clinical practice guidelines exist for the management of AAT deficiency, especially with regards to pulmonary involvement, there are no published recommendations that specifically relate to the management of the liver disease and monitoring for lung disease associated with this condition, particularly in children. Objective: To review the literature on the management of AAT deficiency-associated liver disease in adults and children. Evidence Review: A systematic search for articles indexed in PubMed and published was undertaken. Some earlier selected landmark references were included in the review. Search terms included: “alpha1-antitrypsin deficiency�?; “liver disease�?; “end-stage liver disease�?; “liver transplantation�? and “preventative management�?. Recommendations for the management of children with suspected or confirmed AAT deficiency were made according to the Strength of Recommendation Taxonomy scale. Findings: Liver complications arising from AAT deficiency result from the accumulation of mutated AAT protein within hepatocytes. Liver disease occurs in 10% of children, manifested by cholestasis, pruritus, poor feeding, hepatomegaly, and splenomegaly, but the presentation is highly variable. A diagnostic test for AAT deficiency is recommended for these children. Baseline liver function tests should be obtained to assess for liver involvement; however, the only curative treatment for AAT deficiency-associated liver disease is organ transplantation. Conclusion and Relevance: There should be a greater vigilance for AAT deficiency testing among pediatricians. Diagnosis should prompt assessment of liver involvement. Children with AATdeficiency- associated liver disease should be referred to a liver specialist and monitored throughout their lifetimes for the symptoms of AAT-deficiency-related pulmonary involvement.

Original languageEnglish (US)
Pages (from-to)53-61
Number of pages9
JournalCurrent Pediatric Reviews
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Patient Transfer
Liver Diseases
Liver
Lung
End Stage Liver Disease
Hepatomegaly
Liver Function Tests
Cholestasis
Splenomegaly
Organ Transplantation
Pruritus
Practice Guidelines
Routine Diagnostic Tests
PubMed
Liver Transplantation
Lung Diseases
Hepatocytes

Keywords

  • Alpha1-antitrypsin deficiency
  • Diagnosis
  • Emphysema
  • Pediatric liver disease
  • Pulmonary function tests
  • Systematic review

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Alpha1-antitrypsin deficiency : Transition of care for the child with aat deficiency into adulthood. / Lin, Henry; Kasi, Nagraj; Quiros, J. Antonio.

In: Current Pediatric Reviews, Vol. 15, No. 1, 01.01.2019, p. 53-61.

Research output: Contribution to journalArticle

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abstract = "Importance: Alpha1-antitrypsin (AAT) deficiency is a common, but an underdiagnosed genetic condition, affecting 1 in 1500 individuals. It can present insidiously with liver disease in children. Although clinical practice guidelines exist for the management of AAT deficiency, especially with regards to pulmonary involvement, there are no published recommendations that specifically relate to the management of the liver disease and monitoring for lung disease associated with this condition, particularly in children. Objective: To review the literature on the management of AAT deficiency-associated liver disease in adults and children. Evidence Review: A systematic search for articles indexed in PubMed and published was undertaken. Some earlier selected landmark references were included in the review. Search terms included: “alpha1-antitrypsin deficiency�?; “liver disease�?; “end-stage liver disease�?; “liver transplantation�? and “preventative management�?. Recommendations for the management of children with suspected or confirmed AAT deficiency were made according to the Strength of Recommendation Taxonomy scale. Findings: Liver complications arising from AAT deficiency result from the accumulation of mutated AAT protein within hepatocytes. Liver disease occurs in 10{\%} of children, manifested by cholestasis, pruritus, poor feeding, hepatomegaly, and splenomegaly, but the presentation is highly variable. A diagnostic test for AAT deficiency is recommended for these children. Baseline liver function tests should be obtained to assess for liver involvement; however, the only curative treatment for AAT deficiency-associated liver disease is organ transplantation. Conclusion and Relevance: There should be a greater vigilance for AAT deficiency testing among pediatricians. Diagnosis should prompt assessment of liver involvement. Children with AATdeficiency- associated liver disease should be referred to a liver specialist and monitored throughout their lifetimes for the symptoms of AAT-deficiency-related pulmonary involvement.",
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