Multidisciplinary Management of Alagille Syndrome

Abstract

Jagadeesh Menon,1 Naresh Shanmugam,1 Mukul Vij,2 Ashwin Rammohan,3 Mohamed Rela3 1Department of Pediatric Gastroenterology & Hepatology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India; 2Department of Histopathology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India; 3Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical centre, Bharath Institute of Higher Education and Research, Chennai, IndiaCorrespondence: Jagadeesh Menon, Email [email protected]: Alagille syndrome (ALGS) is an autosomal dominant disorder characterized by involvement of various organ systems. It predominantly affects the liver, skeleton, heart, kidneys, eyes and major blood vessels. With myriads of presentations across different age groups, ALGS is usually suspected in infants presenting with high gamma glutamyl transpeptidase cholestasis and/or congenital heart disease. In children it may present with decompensated cirrhosis, intellectual disability or short stature, and in adults vascular events like stroke or ruptured berry aneurysm are more commonly noted. Liver transplantation (LT) is indicated in children with cholestasis progressing to cirrhosis with decompensation. Other indications for LT include intractable pruritus, recurrent fractures, hepatocellular carcinoma and disfiguring xanthomas. Due to an increased risk of renal impairment noted in ALGS, these patients would require optimized renal sparing immunosuppression in the post-transplant period. As the systemic manifestations of ALGS are protean and a wider spectrum is being increasingly elucidated, a multidisciplinary team needs to be involved in managing these patients. Moreover, many basic-science and clinical questions especially with regard to its presentation and management remain unanswered. The aim of this review is to provide updated insights into the management of the multi-system involvement of ALGS.Keywords: Alagille syndrome, chronic cholestasis, liver transplantation, congenital heart disease, vascular anomalies, multidisciplinary management

Keywords

• alagille syndrome chronic cholestasis liver transplantation congenital heart disease vascular anomalies multidisciplinary management