Long-term nutritional status in pediatric small bowel transplantation

Aim: To review long-term nutritional status in pediatric intestinal transplantion (IT). Patients/Methods: 111 IT were performed in 84 children in our institution (1999-2020): 20% isolated small bowel, 26% liver-small bowel, 3% modified multivisceral and 51% multivisceral grafts. Patients with grafts surviving more than 2 years were included in the study and followed-up: Weight and height were recorded, and Z-score and BMI were calculated every year until the end of the study. Growth curve was analyzed using a mixed model for repeated measures (SAS). The influence of age at transplant, sex, underlying disease, type of graft, immunosuppression protocol, retransplantation, immunological complications and renal insufficiency on outcome were also studied. Results: A total of 65 grafts in 54 patients (33 male/21 female) were included. Median age at transplant was 38 months (6 months-30 years). The main indication was short bowel syndrome (65%), motility disorders (20%) and untreatable diarrheas (9.4%). Prematurity history was confirmed in 30% (n=14). At the end of the study 45 patients were alive with a median follow-up of 10.3 years from transplant (range 2.6-21.6 years). Nine patients were already adults (>18 years old). Only one patient was on home parenteral nutrition (PN) waiting for retransplantation. The rest (n= 44) have a normal life with a normal oral diet (except for food allergies in 65%) and 1-2 bowel movements a day. All of them are off PN (discontinued after a median of 42 days after transplant, range 2- 332 days). The mean Weight Z score increased from -2.12±1.56 at transplant to -1.51±1.44 at the end of the follow-up (p<0.05 only after 2 years from transplant and upon reaching puberty); the Height Z score increased from -2.41± 1.82 to -1.70 ±1.17 respectively (p>0.05). The mean BMI improved from 14.16±2.47 at transplant to 22.27± 0.79 at the end of the study. Neither of the parameters mentioned above did significantly alter outcomes (p>0.05). Conclusions: IT children are expected to achieve a normal nutritional quality of life in the long-term. Although height also improves, catch-up is particularly important in weight after 2 years of transplant.