2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.23 - Nutritional outcomes following small bowel transplantation

Presenter: Rui, Gao, , United Kingdom
Authors: Rui Gao¹, Caroline Kratzing¹, Charlotte Pither¹, Susanna West², Simon Gabe², Andrew Butler¹, Jeremy Woodward¹, Stephen Middleton¹

Nutritional outcomes following small bowel transplantation

Rui Gao¹, Caroline Kratzing¹, Charlotte Pither¹, Susanna West², Simon Gabe², Andrew Butler¹, Jeremy Woodward¹, Stephen Middleton¹

¹Intestinal Failure and Transplantation Unit, Addenbrookes Hospital, Cambridge, United Kingdom; ²Lennard-Jones Intestinal Failure Unit, St Mark's Hospital, Harrow, United Kingdom

Background:

The aim of this analysis was to describe the long-term nutritional outcomes of adult patients following small bowel transplantation (SBT).

Methods:

Between Oct 2009 and Oct 2012, 13 patients received small bowel or multi-visceral transplantation at our centre. Longitudinal anthropometric data were routinely collected to assess nutritional status and allow timely intervention if appropriate.

Results:

13 patients (10 M, 3 F) had 15 transplants. 5 (33.3%) were isolated SBT, 9 (60.0%) were multi-visceral and 1 (6.7%) modified multi-visceral transplant. Mean age at SBT is 41.6 years (SD 9.5; range 29 to 60 years). Mean duration of nutritional follow up was 453 days (SD 366; range 60 to 1034 days).

7 patients (53.8%) were on parenteral nutrition (PN) pre-transplant, with 4 (30.1%) on oral nutritional supplements. Mean handgrip (age and gender adjusted) pre-transplant was 67.5% (SD 17.9%). Anthropometric studies were carried out on average 209 (SD 173) days pre-transplant.

Mean duration of PN post transplantation was 26.9 (SD 33.4) days, with median 18 days. 10 patients maintained nutrition orally in the long term, 2 patients required enteral supplementation, 1 (who had subsequent small bowel infarct and enterectomy) required parenteral support.

Mean handgrip strength reduced by 13.8% (SD 19.2) in the initial 3 months post transplantation, and improved by 6.5% (SD 15.9) within 6 months, 6.6% (SD 15.9) within 12 months, 8.5% (SD 27.4) within 24 months, 15.3% (SD 13) after 24 months. If the two deceased patients were excluded, there was significant improvement in handgrip strength on student t test (p value 0.005).

There were two patients whose handgrip did not improve in the long term follow-up, with handgrip reduction of 36% and 9% after 6 months post transplant. The first patient had severe refractory small bowel rejection and multi-organ failure. The other had restrictive eating pattern with gastroparesis, pancreatic insufficiency and bacterial overgrowth.

There was no significant improvement to MAC, MAMC and triceps. There was loss of weight post transplantation by the end of nutritional follow-up (mean 3.4kg with SD 7.8kg).

Conclusion:

Longterm nutrition can be maintained with oral intake in the majority of patients post SBT. There is significant improvement to handgrip strength post transplant which remains an important marker of clinical nutritional status. Transplantation does not significantly alter weight, albumin or other common anthropometric markers.

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