PE-33: Long-term Nutritional Outcomes of Children Following Intestinal Transplantation

Background: Intestinal transplant (ITx) has become an accepted treatment for infants and children with life threatening complications of intestinal failure and dependence on parenteral nutrition. As ITx improved long-term survival for intestinal failure patient, It is important to look into the long-term nutritional outcome for such patients. Published literature investigated the nutritional and growth outcome for up to 5 years post-ITx and very few investigated up to 10 years post-transplant. Our study aim is to assess patient growth for longer periods post-ITx and investigate factors that could affect nutritional status and ability to maintain gut autonomy without the need for tube feedings. Methods: This is a retrospective study that evaluated the growth, nutritional treatment (parenteral vs. enteral nutrition) and micronutrient status after transplant (Tx) for 134 children transplanted between October 1993 and December 2014. These children fulfilled the criteria of survival of 5 or more years post-Tx. We excluded children who expired prior to 5 years post-Tx or had a second Tx. Z-scores for height, weight and BMI were analyzed at the time of Tx, 5, 10 and 15 years post-Tx. We also analyzed other factors including: Presence of stoma >1 year, prolonged use of steroid, partial gastrectomy, developmental delay, concurrent visceral Tx and episodes of graft rejection. Descriptive statistics and univariate analysis were performed. Results: Characteristics of study cohort are presented in Table 1. Children showed significant improvement in z-score height (p <0.01) and weight (p=0.02) between Tx time and 5 years post-Tx but not thereafter (Table 2). At 5 years post-Tx, children without partial gastrectomy, without small bowel (SB) rejection and lower dose of steroids (< 0.2 mg/kg/day) had greater improvement on linear growth and z-score weight when compared to children who underwent partial gastrectomy, had SB graft rejection or a higher dose of steroids - > 0.2 mg/kg/day (p<0.001, <0.0001 and p<0.01 respectively). Children were more likely to remain on tube feedings if they had developmental delay, partial gastrectomy or an ostomy at 5 years post-Tx (p<0.0001, <0.0001 & <0.001 respectively). Children with partial gastrectomy and developmental delay were more likely to remain on tube feedings at 10 years post-Tx (p<0.0001 for both). At 15 years, 82 % of the children (42/51) were tube feedings independent. Iron, vitamin D and zinc deficiencies were significant during the 15 years of follow up (30-50%). Conclusion: Adequate growth can be difficult to achieve in children who receive ITx. Our data show that as a group these patients showed improvement in growth pattern initially but not long-term, > 5 years post-transplant. Children with developmental delay, partial gastrectomy and an ostomy had more difficulty in becoming tube feedings independent. Close monitoring of micronutrients is needed, on these children, as iron, vitamin D and zinc deficiencies are common.TABLE 1.: Characteristics of Children Undergoing Intestinal Transplant.TABLE 2.: Changes in Z-Scores Weight, Height and Body Mass Index (BMI) in Children Post-transplantaion.