Intestinal absorption rate in children after small intestinal transplantation

Ordonez, Felipe; Barbot-Trystram, Laurence; Lacaille, Florence; Chardot, Christophe; Ganousse, Solène; Petit, Laëtitia Marie; Colomb-Jung, V.; Dalodier, Emmeline; Salomon, Julie; Talbotec, Cécile; Campanozzi, Angelo; Ruemmele, Frank M; Révillon, Y.; Sauvat, Frédérique; Kapel, Nathalie; Goulet, Olivier

doi:10.3945/ajcn.112.050799

Cited by 28 publications

(37 citation statements)

References 35 publications

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“…Second, in contrast to carbohydrate and protein absorption, there is variable absorption of fat early after transplant, reflected in a relatively large SD seen in the French data 8 . The Pittsburgh series showed that at 3 months, both PN‐dependent and PN‐independent patients had rates of fecal fat excretion (inverse of absorption) of 27.5% ± 4.8% and 26.2% ± 3.9%, respectively, 10 similar to the French data.…”

Section: Studies Of Absorptive Functionmentioning

confidence: 56%

“…One of the most thorough studies on absorptive function of transplanted intestine was recently published by the team from Necker Enfant Malades Hospital, in Paris, France 8 . Detailed 3‐day energy balance studies were performed in a cohort of 24 children (6 with liver‐inclusive grafts, 18 without) at the time of complete cessation of PN with weaning to full enteral nutrition (EN); this occurred at a median of 44 days after transplant.…”

Section: Studies Of Absorptive Functionmentioning

confidence: 99%

“…First, by 6 weeks after transplant, the intestinal graft is absorbing energy, particularly carbohydrates, very well overall 8 . This corresponds roughly to the time when many programs are getting patients fully transitioned to enteral calories.…”

Section: Studies Of Absorptive Functionmentioning

confidence: 99%

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Nutrition and Small Bowel Transplantation

2014

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Intestinal transplantation is indicated for patients with intractable intestinal failure, especially when life-threatening complications of parenteral nutrition (PN) occur. The rates of 1- and 5-year graft survival range from 65%–80% and 40%–50% across differing age ranges, with adult recipients generally performing better. Despite nutrition being so central to intestinal transplantation, there are little published literature and essentially no data from clinical trials. In this review, we critically examine published manuscripts in an attempt to draw common themes between various transplant programs, covering experimental physiologic data, published nutrition protocols, and common postoperative management issues. We conclude that the well-established intestinal graft in a healthy state absorbs key nutrients adequately to wean off PN and that the wide variation in practice across different programs suggests that different approaches can equally lead to success.

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Section: Studies Of Absorptive Functionmentioning

confidence: 56%

Section: Studies Of Absorptive Functionmentioning

confidence: 99%

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Nutrition and Small Bowel Transplantation

2014

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“…Growth after ITx depends on a myriad of (patho)physiological mechanisms, starting with the intestinal graft function. Ordonez et al demonstrated fat malabsorption in the majority of children during the initial period after weaning PN. Persistent fat malabsorption was observed in nearly all children 2–18 yr after ITx by Lacaille et al In contrast, their cohort demonstrated adequate amino acid and carbohydrate absorption .…”

Section: Discussionmentioning

confidence: 99%

Energy expenditure and growth failure after intestinal transplantation: A case report

Matthé

Pirenne

Knops

2015

Pediatric Transplantation

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We present a 12-yr-old boy who received a combined liver-pancreas small bowel transplantation at the age of two. The post-operative period was complicated by wound closure problems resulting in a large asymptomatic abdominal wall defect. Further follow-up was uneventful, with the exception of new onset growth failure not explained by extensive routine investigations. An indirect calorimetry was performed. The resting energy expenditure (REE) was significantly increased (126% of predicted), demanding a daily caloric intake of 123 kcal/kg body weight (normal for age: 80 kcal/kg). In the absence of classic reasons for increased REE, a thermal camera revealed increased dermal heat loss at the abdominal wall defect (estimated surplus in energy loss of at least 29 kcal/day: 10.4% of the elevated REE). In addition, we found lower total lung capacity due to impaired abdominal breathing. In the exploration of growth failure in children after (ITx), increased REE must be taken into account. Indirect calorimetry can serve as a valuable diagnostic tool for evaluating individual energy requirements and nutritional support. In this child, exaggerated heat loss through an aberrant abdominal wall could be a potential important contributor to the patient's increased energy requirements.

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“…Combined intestinal and liver TpX is needed in end stage liver failure, a severe complication in SBS patients on long-term PN due to severe intestinal dysmotility, bacterial translocation, and recurrent sepsis. Patients with intestinal grafts often have a suboptimal absorption capacity which necessitates a significant higher energy and micronutrient intake (Ordonez et al, 2013). However, recently excellent results have been published in cases with U-SBS (see long-term result Chapter 13) (Diamanti et al, 2013).…”

Section: Increasing the Absorptive Surface Areamentioning

confidence: 99%