title: Nutrition support after intestinal transplantation: how important  is enteral feeding?
abstract: OBJECTIVE
  Intestinal transplantation is the alternative treatment in patients with irreversible intestinal failure, who depend on long-term parenteral nutrition. Nutrition management after intestinal transplantation should contribute to reducing the risk of graft rejection, to improving gut trophicity and should optimize nutrient absorption, the main goal being to achieve full intestinal autonomy.
  
  
  RESULTS
  Enteral feeding can be administered into the stomach, or directly into the jejunum. Semi-elemental diets are usually used with the aim of improving nutrient absorption and limiting food antigen overload, which might trigger immune stimulation with subsequent increased risk of acute graft rejection. There is no evidence-based reason to use amino acid-based formula. The feeding usually starts with a dilute semi-elemental formula and with a low rate of delivery. The rate and strength of the formula are slowly increased thereafter, according to the individual tolerance. Chylous ascitis and fat malabsorption impair both short-term and long-term nutritional results and are likely to be due to an insufficient reestablishment of the lymphatic circulation of the graft. After an intestinal transplant, patients usually achieve linear growth. However, catch-up growth is rarely observed in stunted patients.
  
  
  CONCLUSIONS
  Nutritional management after intestinal transplantation is challenging and requires a trained, specialized multidisciplinary team.
authors.affiliation: Pediatric Gastroenterology, Hepatology and Nutrition centre, Pediatric Home Parenteral Nutrition centre, Hôpital Necker-Enfants Malades, Paris, France. virginie.colomb@nck.aphp.fr
authors.forename: Virginie
authors.initials: V
authors.lastname: Colomb
authors.forename: Olivier
authors.initials: O
authors.lastname: Goulet
mesh_terms: D004750:Enteral Nutrition / Q000379:methods*; D005526:Food, Formulated; D006801:Humans; D007408:Intestinal Absorption; D007422:Intestines / Q000637:transplantation*; D011184:Postoperative Period