Outcomes of adult patients with intestinal failure after transitioning from a pediatric intestinal rehabilitation program

Background: In living-donor intestinal transplantation (LD-ITx), nutritional outcome may be influenced by variable reduction in length of the intestinal allograft.We aim to review the nutritional status of pediatric recipients of LD-ITx at a single-center.Methods: Medical records of LD-ITx recipients were retrospectively reviewed.The intestinal allograft was taken at least 20-30cm proximal to donor ileocaecal valve, not exceeding onethird of the total small-bowel length of the living-donor.Nutritional protocol consisted of target feed estimation (Schofield equation with stress factor of 1.3-1.5),provision of high-MCT, semi-elemental formula with low osmolality, and multivitamin supplementation.Primary outcome was time to establish target feeds and parenteral nutrition (PN) cessation.Secondary outcome were nutritional parameters at 1-year post-transplant.Results: In 2022-2024, 4 patients aged 6-17 years (median: 8.5 years) underwent isolated LD-ITx (dysmotility=3, short bowel syndrome=1).Median length of intestinal allograft was 150cm (range:100-160).Median time from LD-ITx to PN cessation and achievement of target feeds was 28.5 days (range:19-45) and 37 days (range:19-47) respectively.Median ileostomy output at time of discharge was 46.5ml/kg (range:19-57).Three patients received intravenous fluid replacement post-discharge.At 1-year post-transplant (n=3), improvement in Z-scores for height(3/3), mid-upper-arm circumference(2/3) and triceps skinfold(2/3) was documented (Table ).Improvement in weight Z-scores was evident only from the 2 nd year.Except for folate and magnesium, no other micronutrient deficiency was detected.Conclusions: Reduced-length allografts in LD-ITx were functionally adequate to maintain nutrition and growth in pediatric recipients.However, weight gain may be slow, and fluid and micronutrient supplementation were commonly required in the first year.