Perioperative nutritional therapy in liver transplantation (original) (raw)
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Nutritional assessment and management in liver transplantation
Revista Espanola de Enfermedades …, 2006
Patients eligible for solid organ transplantation are functionally end-stage regarding the organ to be transplanted. Being chronic patients, they usually display malnutrition to some extent (1). Weight loss and other malnutrition signs are considered predictive factors for poor prognosis regarding the outcome of surgical patients, including patients undergoing a solid-organ transplant (2,3). The presence of malnutrition is associated with increased morbidity and mortality, and higher healthcare costs (4). Major malnutrition causes in patients with advanced liver disease include inadequate dietary intake-from anorexia, from drugs and therapy-related dietary changes, or from disease complications-and main nutrient-related metabolic changes (5). Regardless of the underlying disease, a diagnosis of malnutrition is established by a combination of various methods: medical record, anthropometric measurements, biochemical parameters, and body composition. As de Luis et al. suggest in this issue of REED (6), end-stage liver disease itself may greatly modify many of these indices. Ideally, accurate body composition techniques such as K measurement 40 or deuterium concentration should be used. Unfortunately, such techniques require complex equipments available only in a few centers. However, such technical limitations do not justify the omission of nutritional assessments in patients eligible for liver transplantation. Nutritional screening tests are a good tool for the initial assessment of a patient's nutritional status, even when they are not specifically indicated for advanced chronic liver disease (7,8). Anthropometric measurements may also be useful, except when water and salt retention are significant (9). In contrast, plasma concentration measurements regarding some proteins are not so useful in these patients. DXA (dual-energy X-ray absorptiometry) is a method for body composition analysis based on the measurement of a body property, rather than a body component. Many hospitals have this instrument to assess bone mineral density, and it also provides sound information on other body components, including fat mass (10). While some experiences with this method have been reported in patients with cirrhosis (11), its accuracy for patients with water and salt decompensation remains to be definitely established. On the other hand, the accuracy of a bioimpedance analysis depends on the applicability of the regression equation relating current resistance through the body to body composition parameters. This method may scarcely sensitive for the detection of brisk water volume changes, particularly in the abdomen. Despite this, some groups advocate for its usefulness in the assessment of patients with advanced liver disease (12). De Luis et al. have assessed 31 candidates to liver transplantation using nutritional screening tests, anthropometric and biochemical measures, and bioimpedance Nutritional assessment and management in liver transplantation
One-year follow-up of the nutritional status of patients undergoing liver transplantation
Nutricion Hospitalaria, 2016
espanolIntroduccion: la eleccion del metodo para la evaluacion nutricional es fundamental para el correcto seguimiento del estado nutricional de los pacientes sometidos al trasplante de higado. Objetivos: evaluar y comparar el estado nutricional de los pacientes antes y despues del trasplante de higado por el tiempo de un ano para los diferentes metodos de evaluacion nutricional. Metodos: se evaluaron los pacientes que se sometieron a un trasplante de higado en diferentes momentos: pretrasplante, 1, 3, 6 y 12 meses despues del procedimiento, en la Hermandad de la Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil. Los metodos utilizados fueron la antropometria, la fuerza de apreton de manos por la fuerza de agarre no dominante (FAM), el espesor del musculo aductor del pulgar y el angulo de fase (AF) por bioimpedancia electrica (BIA). En todas las evaluaciones se tomaron las mismas medidas. Resultados: las evaluaciones se llevaron a cabo en 22 pacientes. Los metodos que mostraron m...
HepatoBiliary Surgery and Nutrition, 2016
Background: Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. Methods: We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Nutrition assessment was performed by body mass index (BMI), BMI for ascites, albumin, subjective global assessment (SGA) and anthropometry [mid upper arm circumference (MUAC), mid arm muscle circumference (MAMC), and triceps skin-fold (TSF)], Hand Grip strength, and phase angle of the body. Prevalence and comparison of malnutrition was performed with various clinical variables: aetiology, Child Turcotte Pugh scores and model for end stage liver disease (ESLD) grades, degree of ascites, blood product usage, blood loss during the surgery, mortality, days [intensive care unit (ICU), Ventilator and Hospital], and Bio-impedance analysis [weight, fat mass, fat free mass (FFM), muscle mass and body fat%]. Results: Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage , blood loss during the surgery, BIA (fat mass, FFM, muscle mass and body fat%). Conclusions: The different nutrition assessment tools showed great variability of results. SGA showed moderate agreement with phase angle of the body and was associated with various clinical and prognostic variables of liver transplantation.
Assessment of nutritional support in patients after liver and kidney transplantation
Hrvatski časopis za prehrambenu tehnologiju, biotehnologiju i nutricionizam
During the last decades organ transplantation has evolved into a proven therapy for end-stage organ failure. However, the long-term success of organ transplantation depends significantly on the patients’ ability to overcome possible postoperative complications and to recover from a severe metabolic imbalance. Therefore, in the present study we assessed the accuracy of the early post-operative nutritional intake in a vulnerable group of patients after organ transplantation and compared it with the calculated minimal nutritional requirements. A number of 61 patients were included in the study, 48 with liver, 11 with kidney, and two patients with both, liver and kidney transplants. Mini nutritional assessment (MNA) was applied and total nutritional intake was recorded for fourteen consecutive post-transplant days. Serum concentrations of proteins, urea and creatinine, as well as catalytic concentrations of liver enzymes were measured. Urea to creatinine ratio was calculated. According ...
Hepato-gastroenterology
Background: Protein-energy malnutrition is common in patients with end-stage liver disease undergoing liver transplantation. We examined the characteristics of nutritional status and impact of pre-admission branched-chain-amino-acids treatment on skeletal muscle mass, nutritional/metabolic parameters and on posttransplant outcomes. Methods: Preoperative skeletal muscle mass and nutritional/metabolic parameter levels were compared in 129 patients undergoing adult-to-adult living donor liver transplantation whether received branched-chain-amino-acids treatment before admission or not. We examined relationships among these parameters, and risk factors for posttransplant bacteremia and early mortality after LT focusing on nutritional parameters. Results: Prealbumin and branched-chain-amino-acids-to-tyrosine ratio were significantly higher while tyrosine was lower in branched-chain-amino-acids-pre-supplemented than non-pre-supplemented group, while skeletal muscle mass, total lymphocyte ...
Transplant International, 1998
Perioperative parenteral and enteral nutrition for patients undergoing orthotopic liver transplantation. Results of a questionnaire from 16 European transplant units Abstract The present clinical experience in perioperative nutrition for patients undergoing orthotopic liver transplantation was evaluated by a questionnaire, answered by 16/ 21 European transplant units (76.1 %). There is agreement, that malnutrition reflects per se the severity of chronic liver disease and should be not considered, in general, to exclude patients from the transplant waiting list. Most centers administer postoperative nutrition without difference to other patients after gastrointestinal major surgery. A combination of parenteral and enteral nutrition is preferred. Experience with preoperative nutritional support and use of new immunomodulating substances is rather limited.
Nutrition of Liver Transplant Patients
The Canadian journal of gastroenterology, 2000
N utritional status has been shown to be an important prognostic factor in patients with end-stage liver disease undergoing liver transplantation (1-7). In these patients, malnutrition may be related to poor nutritional intake, malabsorption and liver disease itself. Muscle wasting, fat store depletion, impaired immunological function, and decreased vitamin and trace element serum levels may influence patient outcome by prolonging catabolic state, increasing risk of septic complications, and causing long term weaning and intensive care unit stay (8,9). However, there are no detailed clinical guidelines and recommendations with regard to the perioperative nutrition of the liver transplant patient. Only limited data from controlled studies are available, which may well be attributed to transplant units placing a
Impact of dietary intake and nutritional status on outcomes after liver transplantation
Revista Española de Enfermedades Digestivas, 2006
Objective: the aim of our study was to examine, in a prospective way, whether any nutritional parameter could predict outcomes after liver transplantation. Material and subjects: a nutritional assessment was performed in 31 consecutive patients six months prior to undergoing orthotopic liver transplantation (OLT) at a single center (Hospital U. Río Hortega) and after six months of OLT (December 2002-June 2004). The nutritional evaluation included Subjective Global Assessment (SGA), Mini Nutritional Assessment test (MNA), anthropometry, laboratory tests, and three-day diet diary completed. The body composition analysis was performed by tetrapolar body electrical bioimpedance and skin folds in a standard way. Results: our patients had an average age of 56.2 ± 8.11 years; weight was 72.9 ± 15.3 kg, and body mass index was 26.6 ± 4.1. The anthropometric evaluation showed the following data: tricipital skin fold 12.2 ± 6.1 mm, mid-arm circumference 24.5 ± 4.1 cm, fat-free mass 54.5 ± 10.9 kg, fat mass 18.4 ± 6.5 mm, and body water 41.4 ± 9.1 kg. After six months from liver transplantation, these parameters remained unchanged. Energy intake, as corrected by weight, was similar pre-and post-liver transplantation (28.1 ± 6 kcal/kg vs. 27.5 ± 5.8 kcal/kg: ns). Albumin, prealbumin and transferrin improved after 6 months from transplantation. Length of stay in hospital was 22.4 ± 14.9 days, and length of stay in ICU was 0.7 ± 1.7 days. The nutritional status (SGA and MNA tests) of patients did not influence length of stay in either hospital or ICU. No intercurrent events (infections: urinary tract infection, pneumonia, and peritonitis) were recorded during the 6-month study period. Two patients died after liver transplantation (6.5%), and 3 patients had acute rejection (9.6%). Patients with malnutrition (SGA and MNA tests classification) showed no differences in rejection and mortality. Conclusions: our liver transplantation population had normal nutritional status and dietary intake. Nutritional parameters showed no association with outcomes after liver transplantation. Liver transplantation improved serum protein levels and did not modify weight or dietary intake. Further studies are needed to clarify the role of liver transplantation on nutritional status and of nutritional status on liver transplantation outcomes, considering different populations of patients.
Liver Transplantation, 2014
Derangements of various serum biochemical nutritional/metabolic parameters are common in patients with end-stage liver disease who undergo liver transplantation (LT). The aim of this study was to explain the benefit of LT with respect to parameter changes and to examine the impact of the graft-to-recipient weight ratio (GRWR) on such changes. We investigated each parameter's course in 208 adult recipients for 1 year after living donor LT and analyzed changes in the parameters with a GRWR of 0.8% as the cutoff point. Bonferroni corrections were applied to account for multiple testing. Liver diseaseinduced high pretransplant ammonia and tyrosine levels and low branched-chain amino acids to tyrosine ratio (BTR) and zinc levels normalized within 2 weeks after transplantation, and the total lymphocyte count (TLC) normalized within 2 months, whereas low pretransplant prealbumin levels took 1 year to normalize. Branched-chain amino acids (BCAA), zinc, and TLC levels transiently dropped shortly after transplantation and then were corrected later. An accelerated recovery of ammonia and tyrosine levels and the BTR were found with larger grafts, especially early after transplantation, whereas zinc, prealbumin, BCAA, and TLC levels recovered regardless of the graft size. In conclusion, graft size had little effect on the recovery of nutritional/metabolic parameters except for ammonia and tyrosine levels.
Changes in nutritional status after liver transplantation
World Journal of Gastroenterology, 2014
Chronic liver disease has an important effect on nutritional status, and malnourishment is almost universally present in patients with end-stage liver disease who undergo liver transplantation. During recent decades, a trend has been reported that shows an increase in number of patients with end-stage liver disease and obesity in developed countries. The importance of carefully assessing the nutritional status during the workup of patients who are candidates for liver replacement is widely recognised. Cirrhotic patients with depleted lean body mass (sarcopenia) and fat deposits have an increased surgical risk; malnutrition may further impact morbidity, mortality and costs in the post-transplantation setting. After transplantation and liver function is restored, many metabolic alterations are corrected, dietary intake is progressively normalised, and lifestyle changes may improve physical activity. Few studies have examined the modifications in body composition that occur in liver recipients. During the first 12 mo, the fat mass progressively increases in those patients who had previously depleted body mass, and the muscle mass recovery is subtle and non-significant by the end of the first year. In some patients, unregulated weight gain may lead to obesity and may promote metabolic disorders in the long term. Careful monitoring of nutritional changes will help identify the patients who are at risk for malnutrition or over-weight after liver transplantation. Physical and nutritional interventions must be investigated to evaluate their potential beneficial effect on body composition and muscle function after liver transplantation.