Crest Peyton, Stacey Piper, Accurso Erin C, Deley Clara, Roberts John
Department of Surgery, University of California, San Francisco, California, USA.
Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, California, USA.
Pediatr Transplant. 2025 Feb;29(1):e70014. doi: 10.1111/petr.70014.
Following liver transplantation (LT), adequate nutrition is essential, as malnutrition may contribute to slower growth in pediatric patients and put patients at risk of complications following transplant. Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by restrictive eating patterns that compromise nutrition. Patients with ARFID may have significant difficulty meeting nutritional needs due to fear of gastrointestinal distress, making it especially difficult to manage in patients following LT.
We performed a retrospective chart review of de-identified patients who received LT at our institution. Two patients with ARFID who had undergone LT were identified. Their diagnoses, clinical courses, and post LT outcomes are reported. A literature review of the presentation and diagnosis of ARFID in pediatric patients and nutritional management of pediatric LT patients was performed. No IRB review was required given the sample size of two patients, per UCSF IRB rules and regulations.
We present two unique cases of ARFID: one with onset prior to LT and one with onset following LT. Outpatient psychiatry treatment was essential for nutritional management for the patient who developed ARFID following LT. The other patient continues to see a dietitian given ongoing nausea that limits her oral intake but does not receive any psychiatric support.
ARFID and selective eating patterns are rare but notable occurrences after pediatric LT, but they may also be underreported given the novelty of ARFID and the prevalence of gastrointestinal symptoms following transplant. Our case adds to the limited literature on ARFID in children following major surgical procedures and highlights the importance of interdisciplinary care and the importance of nutritional management in pediatric patients prior to and post LT.
肝移植（LT）后，充足的营养至关重要，因为营养不良可能导致儿科患者生长缓慢，并使患者面临移植后并发症的风险。回避性限制性食物摄入障碍（ARFID）是一种饮食障碍，其特征是限制饮食模式，从而损害营养。患有ARFID的患者可能由于害怕胃肠道不适而在满足营养需求方面存在重大困难，这使得在LT术后患者中管理起来尤其困难。
我们对在本机构接受LT的匿名患者进行了回顾性病历审查。确定了两名患有ARFID且接受过LT的患者。报告了他们的诊断、临床病程和LT术后结果。对儿科患者中ARFID的表现和诊断以及儿科LT患者的营养管理进行了文献综述。根据加州大学旧金山分校机构审查委员会（IRB）的规章制度，鉴于样本量为两名患者，无需进行IRB审查。
我们呈现了两例独特的ARFID病例：一例在LT术前发病，另一例在LT术后发病。门诊精神科治疗对于LT术后发生ARFID的患者的营养管理至关重要。另一名患者因持续恶心限制了口服摄入量，继续看营养师，但未接受任何精神科支持。
ARFID和选择性饮食模式在儿科LT术后很少见但值得关注，不过鉴于ARFID的新颖性以及移植后胃肠道症状的普遍性，它们可能也未得到充分报告。我们的病例补充了关于重大外科手术后儿童ARFID的有限文献，并强调了跨学科护理的重要性以及儿科患者LT术前和术后营养管理的重要性。
