Enteral formula use in children after small bowel transplant

The ultimate goal of intestinal transplantation (ITx) is the maintenance of nutritional status enterally/orally. We retrospectively identified children who had received ITx since the inception of our Intestinal Care Center in December 1996 (n = 24; median age, 2.6 years). Two patients died within 2 months of transplant. Enteral formulas used in the remaining 22 patients included the following: amino acid, trace long chain fatty acids (LCT; n = 4); amino acid, medium chain fatty acids (MCT)/LCT fat mix (n = 13); amino acid, LCT fat (n = 1); and peptide, MCT/LCT fat mix (n = 3). Feedings were initiated on an average of 13 days after ITx. The median number of days to complete the total parenteral nutrition (TPN) wean was 30 days, and stoma output measured on an average of 37 mL/kg per day at 1 month posttransplant. Nine patients (41%) advanced to oral intake alone within 2 to 30 months, and 5 patients (23%) were diagnosed with milk allergy through the RAST test (Pharmacia, Uppsala, Sweden). No differences in the initiation of therapy, advancement to oral intake, stoma output, or TPN weaning were observed by the type of formula used. Using z-score statistics, positive linear growth was achieved in 7 of 21 children (33%) over the 1-year period, whereas linear growth velocity was maintained in an additional 6 patients (29%). Successful advancement to total enteral/oral intake and positive growth after ITx can be achieved with either an amino acid- or peptide-based, partial MCT enteral formula initiated within 2 weeks of transplant. Monitoring for posttransplant allergy is recommended because of the high rate of postoperative allergy symptomology.