Nutritional status and outcomes throughout the intestinal transplant journey: Experience from the Cambridge...

Guidance on the optimum nutritional management of patients receiving intestinal transplants (ITx) is limited. We aimed to i) describe the nutritional management of adult ITx patients in the immediate post-ITx period and ii) examine nutritional status using BMI across the ITx journey.

A retrospective analysis included all adult-recipients of an intestine-containing graft at Addenbrooke's Hospital, Cambridge between 2007 and 2024. Data collected included nutritional routes immediately post-ITx (parenteral nutrition-PN, enteral nutrition-EN and oral feeding-OF) and BMI at ITx and 1 yr post-ITx. Associations between baseline BMI (at-ITx) and 1 yr post-transplant (1yr-ITx) were examined using logistic-regression for the risk of being overweight-obese at 1yr-Tx (BMI:<25 vs. ≥25 kg/m²).

166 patients (median age 45 yrs (IQR: 34-53), and 49% female) were included in the study. Duration of PN, EN, and time to OF post-ITx was 24 days (IQR: 14-35); 38days (IQR: 15-82), 13 days (IQR: 9-24), respectively. Median weight loss 3 months post-ITx was 9% of Tx-weight, reducing to 2% at 6 months. In logistic-regression, baseline-BMI (<25 kg/m² vs. ≥25 kg/m²) predicted 1yr-BMI (<25 kg/m² vs. ≥25 kg/m²) [OR:4.9, 95%CI:1.88-12.77], in adjusted analyses. 24% patients with a healthy baseline-BMI became overweight or obese at 1yr-Tx (P < 0.0001).

Our study shows that i) weight loss occurs within the first 3 months post-ITx, though mostly re-gained within 6months; ii) post-MVTx oral diet is initiated by 2 weeks; and iii) baseline BMI is the only significant predictor of 1 yr post-ITx BMI. However, 1 in 4 ITx patients with a healthy baseline BMI were observed to become overweight or obese at 1 yr. Further research is required to elucidate what mechanisms lead to the development of obesity after transplant.