Intestinal, Liver, and Islet Cell Transplantation: ASPEN 2010 Highlights
Micronutrient Supplementation After Achievement of Nutritional Autonomy
Laura Matarese, PhD, RD, FADA, CNSD
- Is absorption of micronutrients affected after intestinal transplantation?
- The assumption is that the achievement of clinical nutritional autonomy is associated with restoration and maintenance of micronutrient status
- However, Dr. Matarese found that some patients are low in serum zinc, vit E, and folate, especially in the early post-operative period
- The majority of intestinal transplant patients are deficient in pyridoxal-5’-phosphate (Am J Clin Nutr 2009;89:204-209)
- Unexplained neuropathy and myopathy in long-tern survivors triggered the search for the underlying cause and undetectable PLP concentrations were discovered
- Ten percent of intestinal transplant candidates were deficient in B6 whereas 96% of transplant recipients became deficient within a median onset of 30 days after transplantation
- All patients were PN-dependent before transplant. Parenteral nutrition was continued post-transplant, tube feeds were begun within the first 2 weeks post-transplant, and most patients were allowed to while on PN or TF. Parenteral nutrition and tube feeds were discontinued once po diet met nutritional goals
- What might be the cause for B6 deficiency? It is hard to know but increased metabolic demand could be of the causes of deficiency possibly triggered by high surgical catabolic phase and high demand for use of B6 as a cofactor
- Dr. Matarese developed a B6 repletion protocol based on serum concentrations of PLP
- If ≥ 3.3 ng/mL à no treatment
- If 2.5 – 3.2 ng/mL à oral supplementation with 50 mg pyridoxine HCl/d
- If < 2.5 ng/mL à initial single IV dose of 50 mg pyridoxine HCl followed by daily oral dose of 50 mg
- Following intestinal transplantation, B6 levels can and will drop within a month
- Check PLP 1 month after transplantation; then every month as needed or following supplementation
Liver Transplantation: Any Guidelines for Nutrient Supplementation?
Jeanette Hasse, PhD, RD, FADA, CNSC
- Vitamin and mineral needs of liver transplant recipients are largely unknown
- Vitamin and mineral needs may be altered due to the original liver disease or complications after transplant
- There are no standard protocols for supplementation at this time (an informal survey of several transplant programs in the country)
- There are no data on vitamin/mineral deficiencies or supplementation in liver transplant recipients
- At Baylor University Medical Center
- 100% liver transplant recipients found to be deficient in Vit D
- 31% were deficient in vit A
- 25% were deficient in vit E
- Two third pts at Baylor take supplements
- Fat-soluble vitamin deficiency is common among patients with cholestatic liver disease (A, D, E)
Bone Health In Individuals Undergoing Islet Cell Transplantation
Diana Mager, PhD, RD
- Original research presented by Diana Mager
- Islet cell transplant is an effective therapy for patients with type 1 DM
- Patients are at risk for reduced bone mineral density (BMD)
- Disease severity, poor nutritional status, weight loss, immunosuppressive therapy
- There are insufficient data regarding the status of bone health in these patients
- A retrospective chart review of 98 islet cell transplant adults who had DEXA scans done
- Collected: anthropometrics, BMD (absolute and T-scores for hip, spine, femoral neck), vit D levels, use of bisphosphonates, HRT, immunosuppressive meds, vitamin and mineral supplements
- Low BMD was common pre- and post-transplant. Significantly low BMD in hip and FN. Prevalence of osteopenia and osteoporosis at the spine, hip and FN increased on DEXA scans done post-transplant
- Eighteen percent of patients had insufficient levels of vit D post-transplant
- Predictors of low BMD: + h/o bone fragility fractures, low BMI, advanced age, use of bisphosphonates
- Conclusion: low BMD is prevalent in islet cell transplant patients pre- and post surgery
- Routine evaluation of BMD & predictors of BMD is warranted in this patient population
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