1. The Benefits of Early Enteral Nutrition in SPK transplant
Sally Finlay
Renal and Transplant Dietitian
D. Chapman, A. Asderakis, E. Ablorsu
University Hospital of Wales, Cardiff

2. Why did we complete the study?
End-Stage Renal Failure & DM
Disease related co- morbidities:
Malnutrition
GI disturbances
Transplant (SPK) related complications:
Reoperation
Infection, etc.
Worsening nutritional status
Is Early Enteral Nutrition Beneficial?

3. Method Collected data:
Monitored Group-MG: 20 retrospective patients ( ) who did not receive a nutritional assessment and nutritional care was not planned
Fed Group-FG: 26 prospective patients ( ) who had been assessed and nutritional care plan agreed
End-point:
assess nutritional intake after transplant
reach target nutritional requirements
>60% by day-7 (7d-60%) and
>60% at time of discharge (total-60%)

4. Demographics Comparison
Factor MG FG p
D-age (years)
40.33±15.05
38.31±14.03
0.769
D-Cr (ml/l)
82.57±32.4
68.84±24.84
0.317
D-BMI
20.98±3.43
20.88±4.16
0.768
D type (DBD/DCD)
16/8
19/7
0.426
R-age (years)
42.46±8.3
40.54±8.3
0.736
R-BMI <20 (%)
8.6
11.5
0.654
RRT (HD/PD)
6/8
9/8
0.670
Weight at assessment (kg)
69.74±7.21
67.17±13.34
0.014
Weight at admission (kg)
68.33±9.66
69.14±12.96
0.156
Initial Alb
34.00±5.82
31.92±5.26
0.464
There was no difference found in the demographics between MG & FG other than weight at assessment

5. Transplant Comparison
Factor MG FG p MM 4
2.5
0.951
Re-operations (%)
45.8
38.5
0.405
Graft loss (%)
12.5
15.4
0.547
Mortality 30 d
CIT (min)
811.63±229.21
745.15±217.25
0.903
PNF (%)
4.3
0.735
There was no difference found in the transplant characteristics between MG & FG.

6. Results (MG vs. FG) Factor MG FG P TPN need (%) 21.05 6.5 <0.0001
Average % requirements met during 1st week
23.25±15.44
39.67±19.52
0.127
Average % requirements met during stay
46.22±19.87
57.42±16.15
0.098
% of stay met >60% requirements
37.41±28.62
49.54±19.25
0.005
LOS
30.58
27.61
0.001
Alb drop (%)
39.54±16.06
50.87±16.44
0.892
Alb reinstate (days)
52.13±37.87
52.80±31.74
0.091

7. Results (MG vs. FG)
SPK transplant patients who receive a post op nutritional plan for EEN meet >60% requirements more frequently within the first week and during their admission.
EEN improves nutritional intake after transplantation mainly in patients with post-operative complications or re-operations
EEN is minimizing need of TPN

8. Sub-analysis (NJ v’s Oral)
FG patients were split between NJ and Oral feeding depending on their nutritional assessment:
weight loss, BMI
Nutrition risk screening score (WAASP)
gastroparesis

9. Sub-analysis (NJ v’s Oral)
NJ group has worse nutritional status

10. Sub-analysis results (NJ v’s Oral)
Initial assessment identifies patients at high nutritional risk
NJ feeding patients with EEN more frequently received >60% requirements during week 1 (p=0.042)

11. Limitations of the Study
Small study
Missing nutritional marker for pts with DM/ESRD
NJ tube related complications (vomiting, discomfort, displacement)

12. Future developments
Pre-transplant nutritional assessment protocol [scoring, monitoring, etc]
Rigorous post-transplant management of nausea, vomiting & constipation or diarrhoea
Benefit of double lumen NJ tube vs. single lumen to aid compliance

13. Acknowledgments
Department of Nephrology and Transplant, University Hospital of Wales, Cardiff
Elijah Ablorsu, Argiris Asderakis, Dawn Chapman
Department of Nutrition and Dietetics, University Hospital of Wales, Cardiff
Novartis pharmaceuticals