Abstracts

WEIGHT GAIN AND OBESITY AFTER INTESTINAL TRANSPLANTATION

Laura Matarese, Lillian Martin, Darlene Koritsky, Guilherme Costa, Geoffrey Bond, Kareem Abu-Elmagd. University of Pittsburgh Medical Center, Thomas E Starzl Transplantation Institute, Pittsburgh, PA.

Purpose: Intestinal transplantation (IT) has recently evolved to be the standard of care for patients with combined intestinal and TPN failure. In addition to restoration of nutritional autonomy, it was observed that some patients became overweight or developed morbid obesity.

Methods: Between May 1990 and December 2005, 188 consecutive patients underwent IT. Height and actual weight were measured and collected prospectively for all patients prior to transplantation and at regular intervals during the post operative period. The body mass index (BMI) (kg/m2) was then calculated at each time point. The study patients were stratified according to the BMI data into underweight (BMI < 18.5), normal (BMI = 18.5-24.9), overweight (BMI = 25-29.9), and obese (BMI 30).

Results: At the time of transplantation, most patients with short bowel syndrome were of normal body weight or underweight. A few cases were overweight with a single example of morbid obesity with strong family history and long-term diabetes. With a mean follow-up of 35+ 35 months, 107 recipients are currently alive with fully functioning grafts and completely off non-volitional feedings. Of these, 12 (11%) that had a normal pretransplant BMI are now overweight. Most of these patients are currently receiving intensive dietary education with discontinuation, if feasible, of the maintenance steroid therapy. Interestingly, one patient who was morbidly obese before transplantation continued to gain weight despite nutrition and exercise intervention.

Conclusion: Overweight and occasionally morbid obesity is a potential complication after IT that could be partially explained by susceptible genetic backgrounds. Accordingly a comprehensive educational program including diet and exercise regimen should be part of the multidisciplinary team approach for the post operative care of this unique population.

Top Updated 9/20/06