Enteral and parenteral nutrition: Considerations for visceral transplant patients

Abstract

Intestinal failure (IF) is a complex malabsorptive disorder that not only leads to multiple health-related complications, but is also closely associated with a reduced quality of life (QOL) due to an intolerance of an oral diet, usually resulting in complete reliance on alternative means of nutrition support. Severe reduction of gut function, impaired intestinal transit time, hypophagia, and almost complete malabsorption of oral macro-and micronutrients are defining characteristics of IF. Due to these complications, patients with IF are often dependent on parenteral nutrition (PN) as the intravenous method for nutrition supplementation to sustain health. Chronic use of PN, however, may result in metabolic and infectious complications. For patients who have irreversible IF and experience complications from PN, multivisceral and intestinal (MV/I) transplantation may be necessary for long-term survival. In addition, protein-calorie malnutrition (PCM) negatively impacts all solid organ and bone marrow transplant outcomes; therefore, a referral to a registered dietitian for nutrition assessment and intervention is crucial to optimize pre-transplant and post-transplant nutrition care. The ultimate goal of MV/I transplantation is to optimize a patient's QOL by establishing full nutritional autonomy, with a full wean from PN and transition to enteral nutrition (EN) and oral diet.