2011 - ISBTS 2011 Symposium

Oral Communications 3: Nutrition Outcomes

5.120 - Absorption after intestinal transplantation

Presenter: Florence, Lacaille, Paris, France
Authors: Felipe Ordonez1, Florence Lacaille1, Olivier Goulet1

Absorption after intestinal transplantation

Felipe Ordonez, Florence Lacaille, Olivier Goulet

Pediatric Hepatogastroenterology-Nutrition, Hôpital Necker-Enfants malades, Paris, France, Metropolitan

Aim: To describe the functional capacity of intestinal allograft, with an analysis of intestinal absorption rate of children after ITx at the time of PN weaning.

Methods: 18 children (1.5 to 10 years) received ITx, with liver in 2 cases and colon in 14 cases, using tacrolimus, steroids and IL-2 blockers. Small bowel graft was put as an ileostomy. PN was tapered as enteral tube feeding (ETF) progressed according to digestive tolerance (stool output) and body weight gain. ETF was based on semi-elemental diet containing 50% energy as lipid with 50% medium chain triglycerides. A few days after PN weaning, intestinal absorption assessment was performed by using 3 days stool balance analysis. Fat, nitrogen, and total energy content were determined by the method of van de Kamer, elemental nitrogen analysis, and bomb calorimetry, respectively. Results were analysed according to the resting energy expenditure (REE) calculated from Schofield formula.

Results: All children were weaned from PN while on full ETF after 31 to 83 days post Tx (median : 44). Median daily stool output at time of analysis was 1137 ml/day (range: 314-2025 ml/day). Median intakes were: energy 108 kcal/kg/day (range: 79-162 kcal/kg/day), lipid 37.5 kcal/kg/day (range: 20-57.5 kcal/kg/day) and nitrogen 18.0 kcal/kg/day (range: 12.7-27.0 kcal/kg/day). The median absorption rates were 85% (range: 75-95%) for energy, 79% (range: 54.5-92.3%) for lipid and 75% (range: 61.5-88%) for nitrogen. The ratio ingested energy/REE and absorbed energy/REE were 2.1 (range: 1.73-3.06) and 1.84 (range: 1.47-2.92), respectively.

Conclusion: PN weaning with appropriate weight gain may be achieved within 1 to 3 months after ITx. The ratios ingested energy/REE and absorbed energy/REE indicate a suboptimal graft absorption rates requiring an energy intake ≥ 2xREE. Energy and nitrogen supplies must be increased and adapted according to the digestive tolerance and to the body weight gain.

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