Nutrition Management of Small Bowel Transplant Patients

Abstract

Nutrition therapy after small bowel or combined liver/small bowel transplantation is challenging. The objective is to restore enteral autonomy to a patient with a complex past surgical history and equally complex posttransplant immunosuppressive regimen in the context of a newly created surgical anatomy. Improved surgical techniques and immunosuppressive regimens have led to superior outcomes. Accompanying these advances is a range of nutrition issues that require specific management strategies. This review outlines the current clinical practice and decision making used to create individualized nutrition regimens for small bowel or combined liver/small bowel transplant recipients. Successful small bowel transplant outcomes require a coordinated effort from a transplant team to restore nutritional autonomy to transplant recipients and free them from parenteral nutrition.

What Is the Normal Small Bowel Length in Humans?First Donor-Based Cohort Analysis

“…Healthy newborns require an average of 120 kcal/kg/day in order to meet their caloric needs and sustain growth. An average 2-year-old child requires 100 kcal/kg/day while an adult only needs 25-30 kcal/kg/day (17,22). Therefore, SBL does not seem to continue growing with age, but a change in diameter occurs that might compensate any further need ( Figure 5).…”

“…Donor's age was included. Other anthropometric variables were calculated, including: Body surface area (BSA; the Mostellers formula) (16), BMI (17), SBL/height (8) and SBL/BSA (18). Donor variables and intestinal length were analyzed using SPSS v17 R (SPSS Inc., Chicago, IL, USA).…”

Parenteral Nutrition

“…60,63 To decrease intestinal bacterial overgrowth and translocation, evidence suggests that use of antibiotics such as oral metronidazole or neomycin are effective not only in reducing liver enzymes but also for symptoms including bloating, gas, foul-smelling stool, and diarrhea. 75,76 Ursodeoxycholic acid is often used to this end and has been shown to decrease serum bilirubin.…”

The Multidisciplinary Approach to the Care of Patients with Intestinal Failure at a Tertiary Care Facility

“…In general, intestinal transplant patients are initially given 25-30 kcal/kg, 1.5-2 g protein/kg, and 30-40 mL/kg using presurgical body weight. 30 Trophic feeds can start as early as postoperative day 2 via a naso-or gastro-jejunal feeding tube. The EN is advanced and typically reaches the goal rate by postoperative day 15.…”