Nutritional Status After Intestinal Transplantation in Children

Abstract

Introduction: The management of children receiving small bowel grafts involves potentially life-threatening complications that affect their nutritional status. The aim of this paper was to define these factors and their influence on nutritional outcome. Patients and Methods: Patients with intestinal failure (IF) who received an isolated small bowel transplantation (SBT) or small bowel/liver transplantation (SBLT) at our hospital during the last 6 years were reviewed for weight Z-score, biochemical nutritional parameters, total parenteral nutrition (TPN) weaning, catheter-related sepsis, rejection and steroid treatment. Results: Twenty patients, 11 females and 9 males, received a SBT or a SBLT and survived the postoperative period; in the present study we only included 11 children with follow-up periods longer than 1 year. Seven males and 4 females with a mean age of 4.5 years (range, 1 to 20 years) received 6 SBLT and 5 SBT. Nine (82 %) were weaned from TPN to an amino-acid or peptide enteral formula during the first 6 months after surgery. During the first year there was a significant increase in total protein from 5.11 ± 1.8 mg/dl to 6.1 ± 1.5 mg/dl (p < 0.05) and an increase in albumin from 3.8 ± 0.9 mg/dl to 4.5 ± 1.1 mg/dl (p < 0.05). There was an increase in weight Z-score in 9 patients (82 %) during the first year. Mean Z-score improved from - 2.6 ± 1 at transplant to - 1.0 ± 0.6 (p < 0.05) after 1 year. Three patients (27.2 %) had at least one rejection period, which was treated with steroids alone or in combination. Mean weight Z-score 1 year after surgery was - 0.9 ± 0.6 for patients without rejection and - 1.24 ± 0.8 for those with at least one rejection episode treated with steroids (p > 0.1). Four patients (36 %) had at least one catheter-related sepsis episode. Mean weight Z-score 1 year after surgery was - 1.01 ± 0.6 for patients without catheter-related sepsis and - 1.24 ± 0.8 for those with at least one catheter-related sepsis episode (p > 0.1). Conclusions: There was a significant improvement in weight Z-score and biochemical nutritional parameters 1 year after receiving a small bowel graft. No influence of steroids or catheter-related sepsis on children's nutritional status was noted 1 year after surgery, although this point will need further evaluation.

Nutritional - intestinal - transplantation - growth - rejection - catheter - sepsis

References

• 1 Bueno J, Ohwada S, Kocoshsis S. et al . Factors impacting on the survival of children with intestinal failures referred for intestinal transplantation.  J Pediatr Surg. 1999;  34 27-33
• 2 Fishbein T, Matshumoto C. Intestinal replacement therapy: timing and indications for referral of patients to an intestinal rehabilitation and transplant program.  Gastroenterology. 2006;  130 S147-S151
• 3 Goulet O, Ruemmele F. Causes and management of intestinal failure in children.  Gastroenterology. 2006;  130 S16-S28
• 4 Gupte G L, Kelly D A, Millar A JW, Booth I W. Current issues in the management of intestinal failure.  Arch Child Dis. 2006;  91 259-264
• 5 Kaufman S S, Atkinson J B, Bianchi A. et al . Indications for pediatric intestinal transplantation: a position paper of the American Society of Transplant Physicians.  Pediatr Transplant. 2001;  5 80-87
• 6 Kelly D A. Intestinal failure-associated liver disease: What do we know today?.  Gastroenterology. 2006;  130 S70-S77
• 7 Koeheler A N, Yaworski J A, Gardner M. et al . Causes and management of intestinal failure in children.  J Pediatr Surg. 2000;  35 380-385
• 8 Mousa H, Bueno J, Griffiths J. et al . Intestinal motility after small bowel transplantation.  Transpl Proc. 1998;  30 2519-2520
• 9 Nucci A, Barkslade E, Yaworski J A, Beserock N, Reyes J. Enteral formula use in children after small bowel transplant.  Nutr Clin Pract. 2002;  17 113-117
• 10 Reyes J, Bueno J, Kocoshis S. Current status of intestinal transplantation in children.  J Pediatr Surg. 1998;  33 243-254
• 11 Steiger E, Faith S RP. Morbidity and mortality related to home parenteral nutrition in parents with gut failure.  Am J Surg. 1983;  145 102-105
• 12 Strom S, Koehler A N, Reyes J. Nutrition management in pediatric small bowel transplant.  Nutr Clin Pract. 1999;  14 58-63
• 13 Sudan D. Cost and quality of life after intestinal transplantation.  Gastroenterology. 2006;  130 S158-S162
• 14 Sudan D, Di Baise J, Torres C. A multidisciplinary approach to the treatment of intestinal failure.  J Gastrointest Surg. 2005;  9 165-176
• 15 Tanner J M, Davies P SW. Clinical longitudinal standard for height and weight velocity for North American children.  J Pediatr. 1999;  107 317-329
• 16 Waseman R, Gilroy R. Nutrition management of small bowel transplant patients.  Nutr Clin Pract. 2005;  20 509-516