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Abstract

Background: There is little information available on the use of parenteral nutrition (PN) in patients after a kidney (KID) or simultaneous pancreas-kidney (SPK) transplantation. This study examined the indications and use of PN in these patients. Methods: Retrospective study of 25 patients (12M/13F; mean age: 51 ± 11 years old) receiving PN after KID or SPK transplantation. Patients were divided in 2 groups according to the number of PN days (group A = <7 days and group B = >7 days). Results: Overall mortality was 16% (group A: 0/7; group B: 4/18). Postoperative ileus (n = 7), intestinal fistula (n = 5), and nausea/vomiting (n = 4) were the most common indications for PN. Functional disorders accounted for 56% (14/25) of the indications for PN. Factors differentiating group A (7/25; median = 5 [4–6] days) from group B (18/25; median =9 [7–31] days) included a significantly higher preoperative serum albumin, SPK transplantation for the first time, and diagnosis of ileus as the indication for PN initiation. Conclusions: Functional disorders of the digestive tract are the primary reason for initiation of PN in isolated KID and SPK transplantation patients. Well-nourished patients undergoing their first SPK transplantation who develop postoperative ileus usually do not need nutrition intervention.

Well-nourished patients undergoing their first simultaneous pancreas-kidney transplantation who develop postoperative ileus usually do not need specialized nutrition support.

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References

Martins C, Pecoits-Filho R, Riella MC. Nutrition for the postrenal transplant recipients. Trans Proc. 2004 ;36:1650– 1654.

Anbar R, Lipa R, Zinger P, Mor E. The role of nutritional support in transplant recipients: two case reports. Trans Proc. 2003 ;35:614– 616.

Aparício M, Chauveau P, Précigout P, et al. Nutrition and outcome on renal replacement therapy of patients with chronic renal failure treated by a supplemented low protein diet. J Am Soc Nephrol. 2000;11:708– 716.

Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD. Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis. 2003 ;42:864– 881.

Cashion AK, Holmes SL, Hathway DK, Graber AO. Gastroparesis following kidney/pancreas transplant. Clin Tranplant. 2004 ;18:306– 311.

Benoit G, Moukarzel M, Verdelli G, et al. Gastrointestinal complications in renal transplantation. Transplant Int. 1993 ;6:45– 49.

Hamwi GJ. Changing dietary concepts. In: Danwoski TS, ed.Diabetes Mellitus: Diagnosis and Treatment . New York, NY: American Diabetes Association, Inc; 1964:73– 78.

Blackburn GL, Bistrian BR, Maini BS, Schlamm HT, Smith MF. Nutritional and metabolic assessment of the hospitalized patient. JPEN J Parenter Enteral Nutr. 1977;1:11– 22.

Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE.Rome II: The Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology, and Treatment: A Multinational Consensus. 2^nd ed. McLean, VA: Degnon Associates;2000 .

10.

Guarnieri G, Toigo G, Fiotti N, et al. Mechanisms of malnutrition in uremia. Kidney Int. 1997 ;52(suppl 62):S41– S44.

11.

Laville M, Fouque D. Nutritional aspects in hemodialysis.Kidney Int. 2000 ;58(suppl 76):S133– S139.

12.

Tritt L. Nutritional assessment and support of kidney transplant recipients. J Infus Nurs. 2004 ;27:45– 51.

13.

Kidney Dialysis Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. Am J Kid Dis. 2000;35(suppl 2): S1–S137.

14.

Djukanovic L, Lezaic V, Blagojevic R, et al. Co-morbidity and kidney graft failure: two main causes of malnutrition in kidney transplant patients. Nephrol Dial Transplant. 2003 ;18(suppl 5):68– 70.

15.

A.S.P.E.N. Board of Directors and the Clinical Guidelines Task Force. Guidelines for use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 2002 ;26(suppl):1SA– 138SA. Errata 2002;26:144.

16.

Sacks GS, Rough S, Kudsk KA. Adverse events associated with parenteral nutrition systems [abstract]. Pharmacotherapy. 2004 ;24:125 .

17.

Trujillo EB, Young LS, Chertow GM, et al. Metabolic and monetary costs of avoidable parenteral nutrition use. JPEN J Parenter Enteral Nutr. 1999;23:109– 113.

18.

Maurer J, Weinbaum F, Turner J, et al. Reducing inappropriate use of parenteral nutrition in an acute care teaching hospital. JPEN J Parenter Enteral Nutr. 1996;20:272– 274.

19.

Braga M, Castoldi R, Cristallo M, Valeri R, Pozza G, Di Carlo V. Catabolic response and parenteral nutrition after simultaneous kidney-pancreas transplantation. Nutrition. 1992 ;8:232– 236.

20.

van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001 ;345:1359– 1367.

Use of Parenteral Nutrition in Patients Receiving Isolated Kidney or Simultaneous Pancreas/Kidney Transplantation

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