title: Energy expenditure and growth failure after intestinal transplantation: A case report.
abstract: We present a 12-yr-old boy who received a combined liver-pancreas small bowel transplantation at the age of two. The post-operative period was complicated by wound closure problems resulting in a large asymptomatic abdominal wall defect. Further follow-up was uneventful, with the exception of new onset growth failure not explained by extensive routine investigations. An indirect calorimetry was performed. The resting energy expenditure (REE) was significantly increased (126% of predicted), demanding a daily caloric intake of 123 kcal/kg body weight (normal for age: 80 kcal/kg). In the absence of classic reasons for increased REE, a thermal camera revealed increased dermal heat loss at the abdominal wall defect (estimated surplus in energy loss of at least 29 kcal/day: 10.4% of the elevated REE). In addition, we found lower total lung capacity due to impaired abdominal breathing. In the exploration of growth failure in children after (ITx), increased REE must be taken into account. Indirect calorimetry can serve as a valuable diagnostic tool for evaluating individual energy requirements and nutritional support. In this child, exaggerated heat loss through an aberrant abdominal wall could be a potential important contributor to the patient's increased energy requirements.
authors.affiliation: Department of Pediatrics, UZ Leuven, Leuven, Belgium.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Matthé
authors.affiliation: Department of Transplantation Surgery, UZ Leuven, Leuven, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
authors.affiliation: Department of Pediatric Nephrology and Solid Organ Transplantation, UZ Leuven, Leuven, Belgium.
authors.forename: Noël
authors.initials: N
authors.lastname: Knops
mesh_terms: D002151:Calorimetry; D002153:Calorimetry, Indirect; D002648:Child; D002149:Energy Intake; D004734:Energy Metabolism; D006130:Growth Disorders / Q000175:diagnosis / Q000209:etiology*; D006358:Hot Temperature; D006801:Humans; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D016035:Pancreas Transplantation / Q000379:methods; D011184:Postoperative Period; D016896:Treatment Outcome
keywords: growth failure; intestinal transplantation; resting energy metabolism