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 sally.finlay@wales.nhs.uk

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?

Method Collected data: Monitored Group-MG: 20 retrospective patients (2007-2009) who did not receive a nutritional assessment and nutritional care was not planned Fed Group-FG: 26 prospective patients (2010-2012) 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%)

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

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.

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

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

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

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

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)

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

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

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