Outcome of gastrointestinal complications after liver transplantation for familial amyloidotic polyneuropathy

Background: Gastrointestinal disturbances are important prognostic factors for mortality and morbidity after liver transplantation for familial amyloi dotic polyneuropathy (FAP). However, the impact of liver transplantation on malabsorption and bacterial small-bowel contamination has not been evaluat ed. Methods: Twenty-three FAP patients were available for the study. They w ere examined for gastrointestinal disturbances as a part of the evaluation for liver transplantation for FAP. Bile acid malabsorption was diagnosed wi th the [Se-75]-homocholic acid taurate (SeHCAT) test; fat malabsorption by measuring faecal fat excretion; and bacterial small-bowel contamination wit h the hydrogen breath test (HBT). Results: No significant improvement of ma labsorption test results were noted from the pretransplant evaluation 8 mon ths (range, 2-20 months) before transplantation to the post-transplant eval uation performed a median of 20 months (range, 9-62 months)after the proced ure. The SeHCAT test result became abnormal in two patients and normal in o ne, and changes in the test correlated with the time the patients were wait ing for transplantation. Faecal fat excretion after transplantation correla ted with duration of the disease and with fat excretion before transplantat ion. A significantly increased fat excretion was noted at the post-transpla nt evaluation. A change in HBT result was noted in only one patient, in who m the test result became normal; pre-transplant Values correlated with thos e obtained after transplantation. Conclusion: For most FAP patients no impr ovement in gastrointestinal function was found after transplantation. The f inding underlines the importance of an early transplantation before the pat ients have developed gastrointestinal dysfunction.