title: The role of nutritional assessment and early enteral nutrition for combined pancreas and kidney transplant candidates.
abstract: BACKGROUND
  Early post-operative enteral nutrition is an important part of perioperative management and is strongly supported by ESPEN Guidelines. However, there is limited evidence into the use of Early Enteral Nutrition (EEN) after combined Pancreas and Kidney Transplantation (PKT). We know malnutrition in type-1 diabetics with end stage renal failure (ESRF) is a common problem and a significant risk factor. Therefore, we introduced EEN in our patients.
  
  
  METHODS
  We monitored and recorded nutritional data on 29 PKT recipients who underwent transplantation between Oct 2007 and Jan 2010 without a nutritional assessment or EEN [Monitored Group (MG)] and on 30 PKT recipients between Feb 2010 and Dec 2013 who received a nutritional assessment and EEN (Naso-jejunal feed or oral intake with supplementation, according to their nutritional status) [Fed Group (FG)]. The end-point was to assess patients' daily post-transplant nutritional intake. This was calculated as a percentage of estimated nutritional requirements using the Schofield equation with a 25% added stress factor and relevant activity factor. Following a literature search and realistic targets our aim was to reach >60% requirements: achievement of ≥60% energy requirements by day-7 (7d-60%) and at the time of discharge (total-60%) [13,14].
  
  
  RESULTS
  There was no significant difference between MG and FG patients in cold ischemic time (CIT), recipient-age and donor-age, Length of Stay and donor-creatinine. In contrast, FG patients were less frequently in predialysis status 41.4% vs. 26.7%, p = 0.001; and had higher incidence of BMI <22.5 kg/m263.3% vs. 48.3%, p = <0.005. In outcomes, FG patients more frequently achieved a higher average % of nutritional requirements in the first week 39.69% vs. 22.37%, p = <0.005; as well as during whole in-patient stay 57.24% vs. 44.43%, p = <0.005 (Table 3, Figs. 1 and 2). The FG spent a greater proportion during the first week 66.7% vs. 31%, p = <0.005; and of whole their admission 93.3% vs. 75.9%, p = <0.005; meeting more than 60% of nutritional requirements. Most important, the need for parenteral nutrition within the FG was significantly lower, 7.1% vs. 20.7%, p < 0.005 (Table 3).
  
  
  CONCLUSIONS
  Our results show that these patients benefit from planned EEN and receive better nutritional support when compared to the patients managed with the historic, reactive approach to nutritional care. Nutritional intake in the first week as well as during the whole admission was superior in patients receiving active EEN despite a more difficult post-operative course due to higher incidence of re-operations compared to the control group. Also the need for parenteral nutrition was significantly lower in this group. In addition, pre-transplant nutritional assessment is beneficial and accurately highlights those who may be at risk of malnutrition pre and post-operatively.
authors.affiliation: Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom. Electronic address: sally.finlay@wales.nhs.uk.
authors.forename: Sally
authors.initials: S
authors.lastname: Finlay
authors.affiliation: Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom.
authors.forename: Argiris
authors.initials: A
authors.lastname: Asderakis
authors.affiliation: Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom.
authors.forename: Adel
authors.initials: A
authors.lastname: Ilham
authors.affiliation: Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom.
authors.forename: Doruk
authors.initials: D
authors.lastname: Elker
authors.affiliation: Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom.
authors.forename: Dawn
authors.initials: D
authors.lastname: Chapman
authors.affiliation: Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom.
authors.forename: Elijah
authors.initials: E
authors.lastname: Ablorsu
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making; D016208:Databases, Factual; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D009753:Nutritive Value; D016035:Pancreas Transplantation / Q000009:adverse effects; D010288:Parenteral Nutrition; D011237:Predictive Value of Tests; D064167:Recommended Dietary Allowances; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Combined pancreas kidney transplant; Early enteral nutrition; Naso-jejunal feeding