2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.7 - Sequential changes in absorptive capacity after intestinal or multivisceral transplantation

Presenter: Maria, Bengtsson, , Sweden
Authors: Maria Bengtsson1, Ingvar Bosaeus1, Markus Gäbel2, Marie Krantz3, Vibeke Malmros1, Jonas Varkey1, Gustaf Herlenius2, Lars Ellegård1

Sequential changes in absorptive capacity after intestinal or multivisceral transplantation

Maria Bengtsson1, Ingvar Bosaeus1, Markus Gäbel2, Marie Krantz3, Vibeke Malmros1, Jonas Varkey1, Gustaf Herlenius2, Lars Ellegård1

1Department of internal medicine and clinical nutrition, Sahlgrenska University Hospital, Göteborg, Sweden; 2Transplantation center, Sahlgrenska University Hospital, Göteborg, Sweden; 3Queen Silvia Children´s Hospital, Sahlgrenska University Hospital, Göteborg, Sweden

 
Background: Intestinal (Itx) and multivisceral transplantation (MVTx) in Sweden is an established treatment modality for patients with irreversible intestinal failure (IF) and life threatening complications of parenteral nutrition (PN).
 
Purpose:Investigate the intestinal graft absorptive capacity after Itx and MVTx
 
Patients: Ten adults (age range 21-67 years) and four children (age range 3-13 years), transplanted between 2001 and 2012. Eleven patients required PN before transplantation (Tx). The remaining patients were transplanted due to neuroendocrine pancreatic tumor.
 
Methods: All food (double portion) and excreta (urine, feces/stomal outputs) were collected during 24 (-48) hours and analysed for energy, nitrogen, sodium, potassium, fat and magnesium. The first absorption tests (A1) were usually done at 3-6 months post Tx, the second (A2) at 6-24 months, the third (A3) at 1-4 years and the fourth (A4) at 3-8 years post Tx. A3 and A4 were initiated by clinical indications to obtain a qualified nutritional status assessment. A1 vs. A2 for 12 patients, and A1 vs. A3 for 8 patients were compared by paired t-test. Due to small numbers of patients and high variability, results are presented as medians.
 
Results:
 
 

A1

n=14

A2

n=12

A3

n=8

A4

n=4
Energy %  74 (20-94)  76a (53-94)  80 (49-91)  82 (67-97)
Nitrogen %  67 (-34-87)  57 (53-94)  74 (49-91)  68 (61-97)
Fluid %  49 (-12-84)  58a (27-87)  76 (-9-87)  44 (-2-71)
Sodium %  18 (-77-80)  49a (-50-80)  61 (-66-83)  -12 (-102-5)
Relative absortion (median values and ranges)
a=p<0,05 by paired t-test between A1 and A2
 
Energy, fluid and sodium absorption improved significantly between A1 and A2, but not nitrogen absorption. No significant changes were detected between A2 and A3.
 
Six patients out of 14 at A1 were requiring partial PN, 6/12 at A2, 2/8 at A3 and 2/4 at A4.
 
Conclusions:
The post-transplant graft absorptive capacity varies greatly between patients and over time, but improves discretely over time. The absorptive capacity seems to depend upon general clinical status, where rejection or infection might have detrimental effects upon the absorptive capacity.
 

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