Nutritional Outcome in Intestinal and Multivisceral Transplant Patients

Abstract

Introduction: Survival following intestinal and multivisceral transplant is improving worldwide.[1] However there is limited data on the nutritional outcomes of these patients. Methods: A total of 62 patients underwent intestinal (12), liver and small bowel (7), modified multivisceral (14) or multivisceral (35) transplant at Addenbrooke’s Hospital, the UK between February 2006 and March 2016. 6 patients had re-transplantations. The most common indications were intestinal failure from short gut and motility disorders. We excluded 12 patients who survived < 6 months and performed retrospective analysis on the remaining 50 patients. Patients were followed up for a median of 37 months, to January 2017 or death (n = 16). The end points included nutritional autonomy (without enteral or parenteral feeding/fluids), change in weight/BMI and anthropometry post-transplant. Results: On average, it took 31 days for patients to be weaned off parenteral nutrition (PN), 61 days off enteral nutrition (EN) in the immediate post-transplant period. The majority achieved nutritional autonomy (74%; 37/50) at the end of follow-up, including patients who had an episode of rejection (19/24). 9 are still taking oral nutritional supplements to maintain their weight. Prior to transplant, 75.7% were dependent on PN (26) and EN (2). Of patients who did not achieve lasting nutritional autonomy, 7 remain on EN, 5 on PN and 1 on parenteral fluids. Reasons for ongoing nutritional support included gastrointestinal symptoms (6), sepsis (2), rejection (4) and renal impairment (1). Post-operatively, 90% patients lost weight of which one third was ≥ 20% of their pre-transplant weight. They reached their nadir weight at a median of 7 months (1–45 months). This subsequently improved with average BMI up by 0.7 kg/m2 (SD=4.5) at 12 months and by 1.6 kg/m2 (SD=4.8) at follow up. The most recent mean BMI is 23.7 kg/m2 (SD=6.4) and further analysis revealed 25 patients at present have BMI of 18.5-25, 10 with BMI <18.5, 9 with BMI >25-30, 2 with BMI >30-35 and 4 with BMI >35. Handgrip strength was measured in 38 patients pre and post-transplant. At median of 9.3 months, there was a slight reduction by 4% of expected value which correlated with their weight loss. 20 patients had further test at median of 21 months and had an average improvement of 7% (SD=0.16). Conclusion: It is common for patients to lose moderate amount of weight following transplant. This improved over time in most patients along with their handgrip strength. The majority were successfully weaned off nutritional support post-transplant. However close monitoring remains essential due to the often complicated post-operative course. Reference: 1. D. Grant, K. Abu-Elmagd, G. Mazariegos, et al. (2015), Intestinal Transplant Registry Report: Global Activity and Trends, Wiley Periodicals Inc., American Journal of Transplantation, 210–219, 15, http://onlinelibrary.wiley.com/doi/10.1111/ajt.12979/pdf, 2016–01–01