Tulpesh Patel², Girish Gupte¹, Deirdre Kelly¹, Kelly Guthrie¹, Sue Protheroe¹, Jaswant Sira¹, JWL Puntis⁴, Gareth Griffiths³, Joel Talcott², Sue Beath¹

¹Birmimgham Children’s Hospital, Birmimgham, United Kingdom; ²Department of Life & Health Sciences, Aston University, Birmimgham, United Kingdom; ³Department of Chemical Engineering and Applied Chemistry, Aston University, Birmimgham, United Kingdom; ⁴The General Infirmary Leeds, Leeds, United Kingdom

The use of lipids in children with intestinal failure has been linked with liver disease and patients who show signs of liver disease have been given Soya-MCT-Oliveoil-Fishoil (SMOF) - a lipid high inw3 fatty acids (FA).

Aim: to measure FA profiles before and12 months post-Tx.

Methods: FAs were extracted from RBCs and analysed by Gas Chromatography-Flame Ionised Detection in two boys (A aged 12, B age 14) who received an isolated SBTx, and combined liver/SBTx respectively.  Intake of FAs was calculated from PN prescription and dietetic records.

Results: Pre-Tx both patients were on identical PN (SMOF 2g/kg/day).  Post-Tx patientA received Peptamen Junior, and patientB Osmolite 1.5cal, neither feed contained PUFAs (Arachidonic acid (AA) or Docasahexaneoic acid (DHA).  The ratio of w6:w3 FA intake increased from 2.5 in SMOF to 7 (Peptamen) and 4.5 (Osmolite) and the intake of EFAs went from 21% in SMOF to 24% and 18% respectively.  The RBC measurements showed that the ratio of w6:w3 FA remained stable pre and post-Tx (patient A w6:w3 = 1.4 to 1.14 and patient B 1.86 to 1.94) although both were above the reference range (1.01 to 1.19).  AA and DHA % levels were high pre-Tx (patientA = 11.29 and 12.14; patientB = 11.05 and 11.48) and remained high post-Tx especially for pro-inflammatory AA (patientA = 11.40 and 9.94); patientB = 10.94 and 10.21) compared to the reference range (AA=8.04 -10.71; DHA=7.65-10.19). 

Conclusion: Both children were able synthesis PUFAs satisfactorily from their enteral food source and maintained w6:w3 biomarker values comparable to age-matched controls.  We conclude that the provision of AA and DHA in PN is not necessary in older children.  The reason for the persistently high level of AA in these two patients is unclear and may relate to sepsis before and after transplant.