Nutritional management of intestinal transplant recipients.

We reviewed our experience with 23 patients submitted to small bowel transplantation between May 1990 and June 1992 at the University of Pittsburgh. Weights at operation and at latest follow-up, as well as the length of time required for complete adaptation to enteral feedings were obtained from the chart. Change in height was measured if the patient was less than 18 years old. Total serum protein. and albumin levels were obtained. Functional studies included the absorption of D-xylose. FK 506. and fecal fat excretion. Motility of the small bowel was assessed at 7 days postoperatively by barium studies. and thereafter when clinically indicated. Abnormalities in absorption. increased stomal output. or dysmotility (rapid or slow transit) prompted aggressive immunologic work-up. Nutritional management during the period of adaptation relied on balanced total parenteral nutrition (TPN) using dextrose. crystalline amino acids. and fat emulsions sufficient to provide 420 kJ/kgld administered by central vein. Enteral feeding was begun once there was evidence of satisfactory gastrointestinal motility. as evidenced by output through the terminal ileostomy. Standard enteral formulas were used (Vivonex. Peptamen. Compleat-B) and advanced as tolerated. Continuous feedings were provided by either nasogastric or nasoduodenal tube. gastrostomy tube (with extension tube past the pylorus). or jejunostomy tube (into the transplanted bowel). Daily stomal outputs were measured for volume. pH. presence of reducing substances. and quantitative bacterial cultures. Steady weight gain on enteral feeds alone was a major criteria for discharge.