Introduction?: There is little published literature on nutrition post intestinal transplant despite it being integral to its management. Current practice at Birmingham Children's Hospital (BCH) is to use a tube feed containing 50% Medium Chain Triglycerides (MCT). At 8-12 weeks Long Chain Triglycerides (LCT) are introduced into the feed, as the intestinal mucosa has recovered, LCT is transported via transected lymphatics into the peritoneal cavity, and absorption is presumed to take place via the peritoneal lymphatics.[1]
A group of patients remained on MCT feeds as the time to change feeds coincided with illness.  A review of published data and protocols concludes that the established intestinal graft in a healthy state absorbs key nutrients adequately to wean off parenteral nutrition, and although there is varying practice different approaches can equally lead to success.[2]
Due to a lack of data, review of our patient’s growth on MCT and LCT is warranted to determine if a change in practice is advantageous.
 

Method?: This study is a retrospective dietetic note review of patients who had a small bowel or combined bowel transplant in the past 10 years at BCH. The group was divided into patients remaining on MCT feeds at 12 months post-transplant versus those changed to an LCT feed at 3 months. Weight and height data was collected at 3, 6 and 12 months post-transplant in addition to feed type.
Exclusions are those who died within the 12 months following transplant. 
 

Results:
95 children had a small bowel or combined transplant in the past 10 years.  26 patients were excluded as they died within 12 months, 17 as notes in archive.
16 remained on MCT feeds at 12 months (31%) whereas 36 were changed to contain LCT at 12 weeks per current protocol (69%).
Despite small numbers differences in the median weight gain and growth between the two groups are seen with the MCT group having superior results.

 

Conclusion: The patients who remained on MCT feeds demonstrate better weight gain and growth than those who were changed to an LCT feed. These results are being analysed to see if they are statistically significant. In all patients the volume of feed given was to meet requirements, and all were supplemented with sodium to a total of 6mmol/100mls.
Based on the findings patients may benefit from MCT feeds for longer, post-transplant, and data should be analysed over a longer period.

Carla Lloyd.

[1] M. Pakarinen et al. Recovery of fat absorption in the transplanted ileum. Transplantation Proceedings.1994; 26: 1665-1666
[2] D. Mercer et al. Nutrition and Small Bowel Transplantation. Nutrition in Clinical Practice.2014; 29: 615-620