Abstract
Introduction: The management of children receiving small bowel grafts involves potentially life-threatening complications that affect their nutritional status. The aim of this paper was to define these factors and their influence on nutritional outcome. Patients and Methods: Patients with intestinal failure (IF) who received an isolated small bowel transplantation (SBT) or small bowel/liver transplantation (SBLT) at our hospital during the last 6 years were reviewed for weight Z-score, biochemical nutritional parameters, total parenteral nutrition (TPN) weaning, catheter-related sepsis, rejection and steroid treatment. Results: Twenty patients, 11 females and 9 males, received a SBT or a SBLT and survived the postoperative period; in the present study we only included 11 children with follow-up periods longer than 1 year. Seven males and 4 females with a mean age of 4.5 years (range, 1 to 20 years) received 6 SBLT and 5 SBT. Nine (82 %) were weaned from TPN to an amino-acid or peptide enteral formula during the first 6 months after surgery. During the first year there was a significant increase in total protein from 5.11 ± 1.8 mg/dl to 6.1 ± 1.5 mg/dl (p < 0.05) and an increase in albumin from 3.8 ± 0.9 mg/dl to 4.5 ± 1.1 mg/dl (p < 0.05). There was an increase in weight Z-score in 9 patients (82 %) during the first year. Mean Z-score improved from - 2.6 ± 1 at transplant to - 1.0 ± 0.6 (p < 0.05) after 1 year. Three patients (27.2 %) had at least one rejection period, which was treated with steroids alone or in combination. Mean weight Z-score 1 year after surgery was - 0.9 ± 0.6 for patients without rejection and - 1.24 ± 0.8 for those with at least one rejection episode treated with steroids (p > 0.1). Four patients (36 %) had at least one catheter-related sepsis episode. Mean weight Z-score 1 year after surgery was - 1.01 ± 0.6 for patients without catheter-related sepsis and - 1.24 ± 0.8 for those with at least one catheter-related sepsis episode (p > 0.1). Conclusions: There was a significant improvement in weight Z-score and biochemical nutritional parameters 1 year after receiving a small bowel graft. No influence of steroids or catheter-related sepsis on children's nutritional status was noted 1 year after surgery, although this point will need further evaluation.
Key words
Nutritional - intestinal - transplantation - growth - rejection - catheter - sepsis
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M.D. J. L. Encinas
Departamento de Cirugía Pediátrica
HU La Paz
Paseo de la Castellana, 261
28046 Madrid
Spain
Email: encinas.j@tiscali.it
