Electrolyte imbalances in pediatric living related small bowel transplantation

Background. Pediatric small bowel transplantations are associated with pronounced electrolyte disturbances in the postoperative period. We investigated the pattern of electrolyte disturbances with regard to enteral malabsorption, renal compensation, and the influence of immunosuppression. Methods. We reviewed 11 small bowel transplantations between October 2002 and February 2007. The data collected included frequent serum, ostomy, and urine electrolyte profiles, renal function parameters, and FK 506 levels in the postoperative period up until either discharge or graft loss. Results. Our results show enteral losses most prominent during the first 4 weeks postoperatively that are only partially compensated by the kidneys. Subsequently, enteral losses improved, although renal function remained challenged, particularly glomerular filtration and phosphorus, magnesium losses, which correlated with high FK 506 levels. Conclusion. Our data reveal several electrolyte imbalances different and unique to postoperative small bowel transplants. Although enteral losses improve along with graft villi formation, electrolyte abnormalities continue, to which FK 506-mediated renal toxicity might contribute.