P1.55: Does BMI Correlate with Enteral Autonomy Post Intestinal transplant?

Abstract

Introduction: Intestinal transplant recipients often require total parenteral nutrition (TPN) support in the post-operative period until they achieve enteral autonomy. The time to enteral autonomy is a meaningful clinical outcome and indicator of successful graft function. Further, minimizing TPN exposure in the heavily immunosuppressed patient may mitigate infectious risk. TPN dependence after intestinal transplantation is variable and nutritional status at the time of transplant may be a determinant of the duration of TPN dependence. Body Mass Index (BMI) is one surrogate of nutritional status in the adult population. The aim of this study was to assess how BMI at the time of transplant impacts the duration of TPN after transplant. Methods: Adult patients who received an intestinal transplant at Georgetown University Hospital from 2006 to 2018, and survived beyond one year after transplant were retrospectively identified. BMI at the time of transplant was categorized based on current definitions (<18.5 indicates malnutrition, 18.5–24.9 healthy weight, 25–29.9 overweight, and >29.9 obesity), and compared to duration of TPN dependence in days. Results: 105 adult patients transplanted between 2006 and 2018 were included in the analysis. 51 of the patients were male and 54 were female. Median age was 43 years (range 18–66). Across all BMI categories the average days of TPN was 19.9 ± 12.6 days. Patients with a higher BMI at the time of transplant had the shortest duration of TPN post-transplant. Patients with a BMI of >30 (n= 11) had a mean of 16.1 ± 7.2 days; patients between 25–29.9 (n = 21) had an average of 18.9 ± 9.2 days; patients between 18.6–24.9 (n = 63) had an average of 20.6 ± 14.8 days; lastly, patients <18.5 (n = 10) had an average of 23.9 ± 8.7 days. There was a significant difference in duration of TPN in days between the <18.5 BMI and >30 BMI category (p=0.05) Conclusion: Achievement of enteral autonomy post-intestinal transplant is multifactorial. It is well established that post-transplant surgical and immunological complications are important factors that play a role in determining when TPN can be successfully weaned. Pre-transplant factors, however, may also contribute to enteral autonomy, such as recipient BMI at the time of transplant. Transplant practitioners should assist patients in avoiding a <18.5 BMI pre-transplant in order to potentially decrease the duration of TPN dependence post-transplant.