Long-term growth and nutrition outcomes in children following intestinal transplantation

Abstract

Objective: Intestinal transplantation (ITx) has become an accepted option for children with serious complications from intestinal failure and parenteral nutrition (PN) dependence. We aimed to assess long-term growth and nutritional outcomes in these patients. We also assessed factors influencing nutritional status and ability to wean off tube feedings (TFs) after ITx.

Methods: We looked retrospectively into post-ITx growth parameters, nutrition treatment, and micronutrient status for children who survived for 5 or more years after ITx. One hundred thirty-three children between 1993 and 2014 were involved. Descriptive data and growth parameters were collected over 15 years after ITx. We also analyzed influencing factors, including the presence of permanent stoma, prolonged use of steroids, partial gastrectomy at the time of ITx, developmental delay, concurrent visceral transplant, and graft rejection episodes.

Results: There was an increase in the height z-scores over the 15-year period post-ITx (p < 0.001). There was a downward trend in body mass index (BMI) z-scores over the 15-year post-ITx period. Isolated intestinal transplant patients showed a better height z-score compared to multivisceral transplant (p = 0.04). The height and BMI z-scores for patients on steroids were not significantly different from the z-scores for steroid-free patients (p = 0.72, 0.99, respectively). There was no significant change in height and BMI z-scores based on prednisolone dose: ≤0.2 mg/kg (p = 0.76); >0.2 mg/kg (p = 0.52). Patients were more likely to require supplemental TF up to 15 years post-ITx when they had partial gastrectomy (p < 0.001), permanent ostomy (p = 0.009), or developmental delay (p < 0.001).

Conclusions: There was improved long-term linear growth post-ITx. Developmental delay, partial gastrectomy, and a permanent ostomy are likely to delay TF wean post-ITx.

Keywords: gastrectomy; ileostomy; pediatric; tube feeds.

Figure 1

BMI and height z‐score changes over time after intestinal transplantation. BMI, body mass index.

Figure 2

TF independence based on gastrectomy, ostomy, and developmental delay status. Time 0 is at the time of ITx; time 1 is at 5 years post‐ITx; time 2 is at 10 years post‐ITx; and time 3 is at 15 years post‐ITx. (A) Percentage of patients staying on TF at 5, 10, and 15 years post‐ITx with versus without partial gastrectomy. (B) Percentage of patients still on TF at 5, 10, and 15 years post‐ITx with versus without persistent ostomy (>1 year post‐ITx). (C) Percentage of patients staying on TF at 5, 10, and 15 years post‐ITx with versus without developmental delay. ITx, intestinal transplant; TF, tube feed.