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Nutritional outcome and growth of children after intestinal transplantation
Kishore Iyer1, Simon Horslen, Angie Iverson
1Section of Transplantation, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Insights
Pediatric intestinal transplantation enables full enteral nutrition. However, children experience significant growth inhibition during transplantation and lack catch-up growth post-procedure.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Pediatric Gastroenterology
Background:
- Intestinal transplantation is a complex procedure for children with intestinal failure.
- Nutritional status and growth are critical outcomes following pediatric transplantation.
- Long-term graft function and patient survival are key considerations.
Purpose of the Study:
- To evaluate the nutritional outcomes in children post-intestinal transplantation.
- To assess linear growth patterns in pediatric recipients after successful intestinal transplantation.
Main Methods:
- Retrospective case-record review of pediatric patients undergoing intestinal transplantation.
- Inclusion criteria: graft survival of at least 1 year.
- Data collection from outpatient charts and computerized databases.
Main Results:
- 47 intestinal transplants were performed in 46 children (isolated small bowel or combined liver-small bowel).
- Survivors with functioning grafts achieved full enteral nutrition.
- Significant pre-transplant growth inhibition was observed, with no catch-up growth post-transplant.
Conclusions:
- Successful intestinal transplantation facilitates the establishment of full enteral feeding.
- Severe linear growth inhibition at the time of transplantation is a significant concern.
- Post-transplant growth velocity is maintained but does not show catch-up growth.
Purpose:
The aim of this study was to determine nutritional outcome and growth in children after successful intestinal transplantation.
Methods:
Case-record review was conducted of all children who underwent intestinal transplantation at a single center and retained their grafts for at least 1 year. Supplementary data were obtained from outpatient charts and computerized database.
Results:
Forty-seven intestinal transplants were carried out in 46 children. There were 19 isolated small bowel and 29 combined liver--small bowel transplant procedures. Median age at transplantation was 3.7 years (range, 0.4 to 16.6 years), and median graft survival time was 1,084 days (range, 368 to 3308 days). Nine patients died, and there were 11 graft losses, including those of the nonsurvivors. All survivors with functioning grafts receive all of their calories via the enteral route. There was significant inhibition of linear growth at the time of transplant in the majority of recipients. After successful transplantation, pretransplant growth velocity appeared to be maintained, but there was no evidence of catch-up growth.
Conclusions:
Intestinal transplantation allows an opportunity for full enteral feedings to be established. There is evidence of severe inhibition of linear growth at the time of transplantation with no evidence of catch-up after transplantation.