Disaccharidase activities and fat assimilation in pediatric patients afterintestinal transplantation

Background. Intestinal transplantation has become an accepted therapy for s hort bowel syndrome and other types of intestinal failure. In order to asse ss digestive capabilities and feeding practices in a group of 22 pediatric patients after intestinal transplantation, we assessed mucosal disaccharida se activities and assimilation of total dietary lipid and vitamin E. Twelve of the patients had undergone contemporaneous liver transplantation. Methods. Mucosal biopsies were assayed for disaccharidase activities betwee n 15 and 412 days after transplantation in 7 of the 22 when all were receiv ing some enteral nutrition and were free of rejection. Coefficients of lipi d absorption were determined in those patients receiving total enteral feed ing (two-thirds polymeric/one-third elemental) between 43 and 1032 days aft er transplantation; oral vitamin E tolerance tests were done at about the s ame time. Results. Activities of lactase, sucrase, maltase, and palatinase consistent ly exceeded reference ranges (P < 0.05). Mean coefficient of lipid absorpti on equaled 86+/-12% and was not influenced by duration of time after transp lantation. No patient required dietary lipid restriction. No significant ab sorption of vitamin E was demonstrated until 160 days after transplantation . Vitamin E absorption did correlate with length of time elapsed after surg ery (r=0.64, P<0.0011). Conclusions. The results of this investigation show that, in the absence of histologic or clinical indications of allograft rejection, pediatric intes tinal transplant recipients do not have primary disaccharidase deficiencies . Similarly, absorption of usual dietary lipid content is adequate once wea ning from parenteral nutrition is complete. In contrast, early assimilation of vitamin E is poor. Vitamin E absorption subsequently improves, but the mechanism is obscure.