title: Long-term nutrition and predictors of growth and weight gain following pediatric intestinal transplantation.
abstract: BACKGROUND
  Advances in intestinal transplantation (ITx) have resulted in improved survival and the opportunity to examine nutritional outcomes. The aim of this study was to describe detailed, long-term nutritional results and identify positive predictors of growth and weight gain following pediatric ITx.
  
  
  METHODS
  A single-center retrospective, Institutional Review Board-approved review of a prospective database was conducted. Inclusion criteria were ITx recipients 18 years or younger with survival of 6 months or more. Outcomes included anthropometric measurements and biochemical markers at 6, 12, 24, 36, and 48 months post-ITx. More than 25 ITx-related variables were analyzed as potential predictors of growth and weight gain. Statistical analysis was performed using chi-square test, t test, and analysis of variance.
  
  
  RESULTS
  Between November 1991 and April 2007, 50 children received 55 ITx; 33 patients met eligibility criteria. Median age at ITx was 2.2 years, follow-up time was 3.8 years, and time from ITx to cessation of total parenteral nutrition was 31 days. The most common micronutrient deficiencies post-ITx were zinc, iron, and copper. Serum protein levels improved significantly over time. Weight gain occurred within 6 months and vertical growth within 12 months, although limited catch-up growth was seen. Early predictors of weight gain and growth included shorter hospitalization and absence of rejection. Long-term predictors were low steroid dosage, infrequent hospitalization, and the use of peptide-based formulas.
  
  
  CONCLUSIONS
  This represents one of the largest and most comprehensive long-term studies on nutritional outcomes in pediatric ITx. Overall, positive growth and weight gain were seen as were micronutrient deficiencies. Numerous long-term nutritional challenges exist which require a multidisciplinary approach and future prospective studies.
authors.affiliation: Pediatric Gastroenterology, Hepatology & Nutrition, Mattel Children's Hospital at UCLA, Los Angeles, CA 90095-1752, USA. Rvenick@mednet.ucla.edu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Venick
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Wozniak
authors.forename: Joanie
authors.initials: J
authors.lastname: Colangelo
authors.forename: Patty
authors.initials: P
authors.lastname: Beckwith
authors.forename: Laurie
authors.initials: L
authors.lastname: Reyen
authors.forename: Yvonne A
authors.initials: YA
authors.lastname: Esmailian
authors.forename: Sue V
authors.initials: SV
authors.lastname: McDiarmid
authors.forename: Jorge H
authors.initials: JH
authors.lastname: Vargas
authors.forename: Marvin E
authors.initials: ME
authors.lastname: Ament
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D048788:Growth and Development / Q000502:physiology*; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000601:surgery; D007422:Intestines / Q000637:transplantation*; D008137:Longitudinal Studies; D008297:Male; D018977:Micronutrients / Q000172:deficiency; D009752:Nutritional Status / Q000502:physiology*; D016377:Organ Transplantation / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D015430:Weight Gain / Q000502:physiology*
chemical_list: D018977:Micronutrients