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Updated: Mar 28, 2026
Orthotopic Small Bowel Transplantation in Rats
Published on: November 6, 2012
Energy expenditure and growth failure after intestinal transplantation: A case report
Stefanie Matthé1, Jacques Pirenne2, Noël Knops3
1Department of Pediatrics, UZ Leuven, Leuven, Belgium.
Insights
Growth failure in a pediatric transplant patient was linked to increased resting energy expenditure (REE). A large abdominal wall defect caused significant heat loss, contributing to higher caloric needs and impacting lung capacity.
Area of Science:
- Pediatric Gastroenterology
- Transplant Surgery
- Metabolic Medicine
Background:
- A 12-year-old boy underwent combined liver-pancreas small bowel transplantation at age two.
- Post-operative complications included a large abdominal wall defect due to wound closure issues.
Observation:
- The patient experienced unexplained growth failure despite extensive investigations.
- Indirect calorimetry revealed significantly increased resting energy expenditure (REE) at 126% of predicted.
- Thermal imaging identified increased dermal heat loss from the abdominal wall defect.
Findings:
- The elevated REE necessitated a daily caloric intake of 123 kcal/kg.
- Estimated surplus energy loss from the abdominal defect was at least 29 kcal/day (10.4% of elevated REE).
- Lower total lung capacity was observed, potentially due to impaired abdominal breathing.
Implications:
- Increased REE should be considered in evaluating growth failure post-intestinal transplantation (ITx).
- Indirect calorimetry is a valuable tool for assessing individual energy requirements and guiding nutritional support.
- Exaggerated heat loss through abdominal wall defects may significantly contribute to increased energy demands in pediatric transplant recipients.
Abstract:
We present a 12-yr-old boy who received a combined liver-pancreas small bowel transplantation at the age of two. The post-operative period was complicated by wound closure problems resulting in a large asymptomatic abdominal wall defect. Further follow-up was uneventful, with the exception of new onset growth failure not explained by extensive routine investigations. An indirect calorimetry was performed. The resting energy expenditure (REE) was significantly increased (126% of predicted), demanding a daily caloric intake of 123 kcal/kg body weight (normal for age: 80 kcal/kg). In the absence of classic reasons for increased REE, a thermal camera revealed increased dermal heat loss at the abdominal wall defect (estimated surplus in energy loss of at least 29 kcal/day: 10.4% of the elevated REE). In addition, we found lower total lung capacity due to impaired abdominal breathing. In the exploration of growth failure in children after (ITx), increased REE must be taken into account. Indirect calorimetry can serve as a valuable diagnostic tool for evaluating individual energy requirements and nutritional support. In this child, exaggerated heat loss through an aberrant abdominal wall could be a potential important contributor to the patient's increased energy requirements.
