Serum Micronutrients Levels Are Maintained Post-Intestinal Transplant in Keeping with Graft Function

Abstract

Introduction: Chronic intestinal failure is defined by the lack of absorption of micro/macronutrients/water and requiring intravenous support. Frequently patients require intravenous micronutrient and mineral support. Following intestinal transplant (ITx) patients no longer require parenteral nutrition (PN). This study was to look at patients who had been transplanted in a single center and to assess the absorption of micronutrients. Methods: This was a retrospective analysis of a prospectively entered database. Biochemical results were taken from patients being assessed for ITx and at 3, 6, 12 months (m), then 12-monthly. Data are inclusive of results from a range either side of timepoints: e.g. 6m includes 4.5-9m, 12m includes 9-18m. Data were reported as mean ±95% confidence interval and analyzed on Prism using one-way ANOVA and Tukey multiple comparisons test. Results: 34 patients received 35 transplants: mean age was 41.9y (range 23–73), M/F: 22:14, median followup was 774d (range 16–3029). Indications for transplantation included Crohn’s disease (7/36,19%), intra-abdominal desmoids (4/36,11%), visceral neuromyopathy (5/36,14%), vascular ischaemia (6/36,17%), radiation enteritis (2/36,6%), neuroendocrine tumor (1/34, 3%), pseudomyxoma peritonii (6/36,17%) and other (5/36,13%). Zinc, folic acid, B12 and Vitamin D levels were statistically significantly different (one way ANOVA): Zinc (p<0.0001) with significant Tukey for pre-ITx(16.9 ±1.07) vs. 12m(14.2 ±1.2, p<0.05), vs. 24m(13.5 ±1.5, p<0.05), vs. 36m(12.9 ±1.4, p<0.005) and vs.48m (13.2 ±1.2, p<0.005); Folic acid (p=0.0006) with significant Tukey for pre-ITx(10.1 ±0.9) vs. 3m(6.6 ±1.0, p<0.05), vs. 6m(5.71 ±1.3, p<0.05); and between 3m vs. 24m(11.7 ±2.5, p<0.005) and 6m vs. 24m(p<0.005); B12 (p=0.0349) with significant Tukey for 6m(883.2 ±202.8) vs. 24m (555.8 ±121.3); Vitamin D (p=0.0469) without significant Tukey (see Fig 1). Copper, selenium and transferrin saturation were not statistically different. Manganese had too few data points for meaningful study and ferritin had too many high values due to being an acute phase protein to determine significance.FigureConclusion: The changes in micronutrients observed demonstrates a functioning graft and good nutritional intake/supplementation. The reduction in zinc, folate and B12 is likely physiological than clinically significant, as levels are within normal ranges. It is reassuring to observe that the ITx is not deleterious to micronutrient metabolism.