Long-term nutritional outcome after pediatric intestinal transplantation.
OBJECTIVE
The aim of this study was to describe the long-term nutritional status of a large population of children after intestinal transplantation and to identify factors associated with nutritional outcomes.


METHODS
Longitudinal anthropometric data are maintained in a database registry for all patients referred to our Intestinal Care Center (ICC). Z-scores for weight and height were calculated biannually over a maximum of 2 years, and associations between baseline and follow-up laboratory measures and growth were evaluated for patients greater than 6 months post intestinal transplant.


RESULTS
Since the inception of the ICC in December 1996, 24 pediatric patients (18 boys, 18 white) received an isolated small bowel or small bowel/liver transplant (median age, 3.2 years). The majority of cases (75%) had been diagnosed with surgical short bowel syndrome and were dependent on total parenteral nutrition (TPN) at the time of transplant. Of the 23 patients who survived the initial postoperative period, 87% were weaned from TPN to an amino-acid or peptide-based enteral formula or solid food within 3 months. A positive trend in z-scores for weight and height/length was observed in only 30% and 26% of patients, respectively, during the follow-up period. Although mean albumin levels increased significantly from 2.8 to 3.1 mg/dl by 6 months posttransplant (P <.01) no difference in alkaline phosphatase was found over time. Steroid doses were weaned within 3 to 4 months after transplantation but not discontinued. The cumulative survival rate was 91% at 1 year and 86% at 2 years posttransplant, whereas those weaned from TPN achieved 100% and 94% survival, respectively.


CONCLUSIONS
Attainment of positive linear growth remains a challenge in the pediatric transplant population despite successful liberation from TPN, protein anabolism, and high survival rates. Further investigation into alternative methods of nutritional evaluation and manipulation as well as the use of growth factors to enhance the growth process need to be investigated.
Nucci
Anita M
AM
Clinical Nutrition Department, Department of Pediatric Surgery, Intestinal Care Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Barksdale
Edward M
EM
Beserock
Natalie
N
Yaworski
Jane Anne
JA
Iurlano
Kathy
K
Kosmach-Park
Beverly
B
Reyes
Jorge
J
D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D002675:Child, Preschool; D006801:Humans; D007421:Intestine, Small / Q000502:physiology* / Q000637:transplantation*; D016031:Liver Transplantation / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D009752:Nutritional Status / Q000502:physiology*; D011788:Quality of Life; D016896:Treatment Outcome