Enteral nutrition is contraindicated in the early post transplant period due to which major factor in adult hematopoietic cell transplants?

• A. Increased sinusitis with enteral feedings.
• B. Lack of benefit from enteral feedings in allogeneic patients.
• C. GI toxicities related to the conditioning regimen.
• D. Improved survival seen in autologous patients receiving PN.

Answer: (C)

GI mucosal injury from the conditioning regimen is the primary reason enteral nutrition is contraindicated early after hematopoietic cell transplantation. High-dose chemotherapy and/or total body irradiation damage the rapidly dividing cells lining the gut, causing mucositis, edema, ulceration, and impaired motility. This compromises the gut barrier and can lead to severe GI symptoms, feed intolerance, aspiration risk, and bacterial translocation with potential infection. Because the gut is not yet capable of safely handling nutrients, parenteral nutrition is often used initially to meet caloric and protein needs while the mucosa heals. Once GI integrity improves, enteral feeding can be gradually reintroduced. The other options do not capture the principal issue driving this contraindication; sinusitis isn’t the major concern, enteral feeding isn’t universally nonbeneficial in allogeneic patients, and survival differences between autologous recipients on PN are not the mechanism behind the contraindication.