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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EA compromised nutritional status influences outcomes and complications before and after transplantation, including survival. Although there is increasing understanding of the influence of changes in energy requirements and body composition among other factors on outcomes, the optimal nutrition strategies have not been defined. Enteral and parenteral nutrition play a role, but other strategies must be identified through future research.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eenteral nutrition\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eintestinal failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eintestinal transplantation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eliver transplantation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epediatric hematopoietic cell transplantation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eparenteral nutrition\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esepsis\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ETransplantation creates unique nutritional demands, and optimal nutrition is needed to improve short- and long-term outcomes in patients. New insights into nutrition based on research and clinical practice in the settings of pediatric hematopoietic cell transplantation (HCT), intestinal transplantation, and liver transplantation were reviewed.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EHCT creates a unique nutritional situation in children, which is influenced by their medical history, the presence of inflammation or infection, previous treatments, and toxicity to the transplant regimen or other therapies. Nutrition is a concern both during and after the transplant period, according to Lori J. Bechard, PhD, RD, Boston Children\u2019s Hospital, Boston, Massachusetts, USA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EEnergy requirements, body composition, and bone health in children change during HCT. Surprisingly, in a prospective study, resting energy expenditure (REE) significantly (\u003Cem\u003EP\u003C\/em\u003E\u2009\u0026lt;\u2009.0001) declined after HCT, reaching its nadir of 80% predicted REE at about 4 weeks and then increasing but not reaching pre-HCT levels in children receiving parenteral nutrition (PN) designed to supply their REE, as measured by weekly indirect calorimetry [Duggan C et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E. 2003]. A significant (\u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.03) decrease in midarm muscle area was found and may possibly drive the reduced REE. Another study confirmed that percent body fat is increased while lean body mass is decreased, whether or not PN was titrated to REE, through day 100 post-HCT [Sharma TS et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E. 2012]. An association was found between reduced arm muscle area and reduced survival [Hoffmeister PA et al. \u003Cem\u003EBiol Blood Marrow Transpl.\u003C\/em\u003E 2013]. These data suggest additional strategies are needed to preserve lean body mass and increase patient survival post-HCT.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EBone mineral density can be deleteriously affected after HCT [Le Meignen M et al. \u003Cem\u003EBlood.\u003C\/em\u003E 2011], and the reductions in bone mineral density and bone mineral content occur as early as the first 30 days [Bechard LJ \u003Cem\u003EPediatr Blood Cancer\u003C\/em\u003E. 2015]. Vertebral compression fractures were found in about 20% of children after HCT [Taskinen M et al. \u003Cem\u003ECancer\u003C\/em\u003E. 2007].\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe feasibility of enteral nutrition (EN) for children during HCT was shown by a retrospective study in which body weight and body mass index (BMI) were maintained and by a prospective comparison against PN in which the 77% of patients receiving EN maintained their weight, had faster platelet recovery (\u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.01), and shorter length of stay (\u003Cem\u003EP\u003C\/em\u003E\u2009\u0026lt;\u2009.001) [Azamoush S et al. \u003Cem\u003EBone Marrow Transpl\u003C\/em\u003E. 2012]. The children who are candidates for EN must be determined by further study.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EVitamin D deficiency is common in children after HCT [Bechard LJ \u003Cem\u003EPediatr Blood Cancer\u003C\/em\u003E. 2015; Campos DJ et al. \u003Cem\u003ENutr\u003C\/em\u003E. 2014; Duncan CN et al. \u003Cem\u003EBiol Blood Marrow Transp.\u003C\/em\u003E 2011]. An association was found between vitamin D deficiency at baseline and outcomes (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E), including mortality, relapse, and transplant failure, and further research is needed to determine its role [Hansson ME et al. \u003Cem\u003EBiol Blood Marrow Transplant\u003C\/em\u003E. 2014].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16133\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16133\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16133\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EBaseline Vitamin D Levels Associated With Outcomes Post-HCT\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EThe use of parenteral lipids containing olive oil [Hartman C et al. \u003Cem\u003EClin Nutr\u003C\/em\u003E. 2009], fish oil [Gura KM et al. \u003Cem\u003EClin Nutr\u003C\/em\u003E. 2005], and a blend of soybean and fish oils [Baena-Gomez MA et al. \u003Cem\u003EAnn Nutr Metab\u003C\/em\u003E. 2013] has been studied in small samples of this population.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EIntestinal Transplantation and Nutrition\u003C\/h2\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EHome parenteral nutrition (HPN) and ultimately intestinal transplantation are treatments for intestinal failure, defined as gut function below the minimum necessary for sufficient absorption of macronutrients, water, or electrolytes to sustain health or growth and thus requiring intravenous supplementation. The indications for HPN are shown in \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E [Staun M et al. \u003Cem\u003EClin Nutr\u003C\/em\u003E. 2009].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16134\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16134\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16134\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EIndications From ESPEN for HPN for Intestinal Failure\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EThe major complications with HPN are catheter-related or metabolic (liver abnormalities, biliary stones, bone disease, trace element\/vitamin deficiencies, manganese toxicity, impaired renal function). Others include psychological, quality of life, and rehabilitation issues, stated Andr\u00e9 Van Gossum, MD, PhD, H\u00f4pital Erasme, Brussels, Belgium.\u003C\/p\u003E\n         \u003Cp id=\u0022p-21\u0022\u003ERecommendations to prevent HPN-related liver diseases include the following: to encourage oral food intake and a cyclical HPN regimen; to limit intestinal bacterial overgrowth; to avoid toxic factors and rapid and adequate treatment of sepsis; to limit lipid intake to \u0026lt;\u20091\u2009g\/kg\/d; to protect bile salt composition supplementation with urso-deoxycholic acid; and to consider a combined liver and intestinal transplant for patients with cirrhosis and hepatic failure.\u003C\/p\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EHPN dependence can result from adaptation of the colonic flora or intestinal capacities, but reversal has been shown up to 5 years after its onset [Amiot A et al. \u003Cem\u003EClin Nutr.\u003C\/em\u003E 2012; Pironi L et al. \u003Cem\u003EGut\u003C\/em\u003E. 2011]. In patients with short bowel syndrome, EN improved intestinal absorption [Joly F et al. \u003Cem\u003EGastroenterology\u003C\/em\u003E. 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003EIntestinal transplants have increased in recent years and are primarily performed in North America. Five-year survival in patients on HPN who were candidates for a transplant was 73% vs 87% in those who were not candidates [Pironi L et al. \u003Cem\u003EGut\u003C\/em\u003E. 2011]. Other data from this study indicate the need for early referral for transplant for patients with intestinal failure and HPN-associated liver failure or invasive intra-abdominal desmoids. Indications for a pre-emptive or rehabilitative transplant are major central venous-catheter-related complications or ultra-short bowel syndrome.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EImpact of Nutrition on Liver Transplantation\u003C\/h2\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EPatients may wait for liver transplantation for years, and during this time, sarcopenia develops in half of patients [Cruz RJ Jr et al. \u003Cem\u003ETransplantation.\u003C\/em\u003E 2013], with the prevalence decreasing with increasing BMI [Tandon P et al. \u003Cem\u003ELiver Transplantation\u003C\/em\u003E. 2012]. Transplant outcomes are affected by body composition and malnutrition before transplantation and nutrition therapy before and after transplantation, stated Jeanette Hasse, PhD, Baylor University Medical Center, Dallas, Texas, USA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-25\u0022\u003EIncreased muscle wasting was associated with decreased survival in patients with sarcopenia following liver transplantation in 2 studies [Montano-Loza AJ et al. \u003Cem\u003EClin Gastroenterol Hepatol\u003C\/em\u003E. 2012; Englesbe MJ et al. \u003Cem\u003EJ Am Coll Surg\u003C\/em\u003E. 2010], but not in another study [Montano-Loza AJ et al. \u003Cem\u003ELiver Transpl\u003C\/em\u003E. 2014]. In the latter study, sarcopenia influenced the length of hospitalization and the prevalence of infections; patients with sarcopenia were more likely to experience post-transplantation bacterial, viral, and fungal infections than their nonsarcopenic counterparts.\u003C\/p\u003E\n         \u003Cp id=\u0022p-26\u0022\u003EIn another study, patients were grouped by tertiles of total psoas muscle area [Krell RW et al. \u003Cem\u003ELiver Transpl\u003C\/em\u003E. 2013]. Patients with the greatest muscle wasting had \u0026gt;\u20094-fold higher risk of developing a severe infection vs patients with the least muscle wasting (OR,\u20094.6; 95% CI,\u20092.25 to 9.53). Age of the transplant recipient (HR, 1.04; \u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.02), pretransplant psoas muscle size (HR 0.38, \u003Cem\u003EP\u003C\/em\u003E\u2009\u0026lt;\u2009.01), and pretransplant total bilirubin level (HR, 1.05; \u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.02) were independently associated with the risk of developing severe infections. A severe infection was associated with a worse 1-year survival vs no infection (76% vs 92%, \u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.003).\u003C\/p\u003E\n         \u003Cp id=\u0022p-27\u0022\u003EEN after liver transplantation has been shown to improve outcomes, including a reduction in reduced bacterial sepsis and early graft loss when initiated within 48 hours [Ikegami et al. \u003Cem\u003EJ Am Coll Surg\u003C\/em\u003E. 2012]. Perioperative immunonutrition provided to improve nutrition status before transplantation did not improve postoperative outcomes including rates of infection in a randomized study [Plank LD et al. \u003Cem\u003EHepatology\u003C\/em\u003E. 2015]. Continued research is needed to determine nutrition therapies to improve outcomes.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/3\/25.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlrpp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlrpp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}