Nutritional status and outcomes throughout the intestinal transplant journey: Experience from the Cambridge Intestinal Transplant Unit

Background: Guidance on the optimum nutritional management of patients receiving intestinal transplants (ITx) is limited.We aimed to i) describe the nutritional management of adult ITx patients in the immediate post-ITx period and ii) examine nutritional status using BMI across the ITx journey.Methods: A retrospective analysis included all adult-recipients of an intestine-containing graft at Addenbrooke's Hospital, Cambridge between 2007 and 2024.Data collected included nutritional routes immediately post-ITx (parenteral nutrition-PN, enteral nutrition-EN and oral feeding-OF) and BMI at ITx and 1 yr post-ITx.Associations between baseline BMI (at-ITx) and 1 yr posttransplant (1yr-ITx) were examined using logistic-regression for the risk of being overweightobese at 1yr-Tx (BMI:<25 vs. 25 kg/m 2 ).Results: 166 patients (median age 45 yrs (IQR: 34-53), and 49% female) were included in the study.Duration of PN, EN, and time to OF post-ITx was 24 days (IQR: 14-35); 38days (IQR: 15-82), 13 days (IQR: 9-24), respectively.Median weight loss 3 months post-ITx was 9% of Txweight, reducing to 2% at 6 months.In logistic-regression, baseline-BMI (<25 kg/m 2 vs. 25 kg/ m 2 ) predicted 1yr-BMI (<25 kg/m 2 vs. 25 kg/m 2 ) [OR:4.9, 95%CI:1.88-12.77], in adjusted analyses.24% patients with a healthy baseline-BMI became overweight or obese at 1yr-Tx (P < 0.0001). Conclusion:Our study shows that i) weight loss occurs within the first 3 months post-ITx, though mostly re-gained within 6months; ii) post-MVTx oral diet is initiated by 2 weeks; and iii) baseline BMI is the only significant predictor of 1 yr post-ITx BMI.However, 1 in 4 ITx patients with a healthy baseline BMI were observed to become overweight or obese at 1 yr.Further research is required to elucidate what mechanisms lead to the development of obesity after transplant.