Identification of high- and low-risk patients before liver transplantation: A prospective cohort study of nutritional and metabolic parameters in 150 patients (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
Clinical and nutritional evaluation indicators of patients on waiting list for liver transplantation
2019
Objective: Comparing different methods of clinical and anthropometric assessment of pre-liver transplant patients. Methods: This was a cross-sectional study with quantitative approach. We analyzed data from the medical records of pre-transplant patients older than 18 who received care at a Nutrition outpatient clinic of a Liver Transplant Center in Fortaleza-CE. We collected data regarding patient identification, clinical diagnosis, nutritional assessment and diagnosis. This study was approved by the Ethics Committee in Research of Walter Cantidio University Hospital of the Federal University of Ceara. Data were analyzed in the statistical program SPSS TM version 17.0 Results: The sample consisted of 71 patients, with 46 men (64.8%) and 25 women (35.2%), with a mean age of 53.7 years. The average BMI was 27.2 kg/m2; most women were healthy (60.0%) and most men were with excess of body weight (69.0%). As for the nutritional diagnosis according to the percentage of adequacy of the mid...
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.
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...
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.
Long-Term Results of Liver Transplantation in Patients 60 Years of Age and Older
Transplantation, 1998
This retrospective analysis aims to evaluate results of hepatic based metabolic disorders as an indication for liver transplantation in a single center experience with regard to survival, metabolic cure and improvement of quality of life. Patients and methods: From 1991-2003, 363 patients have been transplanted in our center out of which 66 (17,8%) suffered from metabolic disorders: BylerЈs disease (PFIC2, n ϭ 17), MDR3-defect (PFIC3, n ϭ 11), Crigler-Najjar syndrome (CRNA, n ϭ 9), hyperoxaluria type 1 (OXAL. n ϭ 8), a1-AT deficiency (A1ATD, n ϭ 6), WilsonЈs disease (WЈd, n ϭ 4), neonatal hemochromatosis (NHC, n ϭ 4), tyrosinemia type 1 (Ty I n ϭ 3), urea cycle defects (UCD) :OTC-deficiency (OTC-d, n ϭ 2) Citrullinemia (n ϭ 1)., glycogen storage disease type 4 (GSD IV, n ϭ 1) and cystic fibrosis (CF, n ϭ 1). The diagnosis was based on classical clinical, biochemical and in some cases on molecular biological findings. The indication was fulminant liver failure (n ϭ 10), chronic liver failure (n ϭ 38), failure of a second organ (n ϭ 4) and preemptive (n ϭ 14). Transplantation technique was full size organ (n ϭ 15), reduced size (n ϭ 7), split-liver (n ϭ 30) and LR-LTX (n ϭ 14). Survival was calculated using the Kaplan-Meyer method. Results: The survival of the individual disorders is shown in table 1: The overall ten year survival of these patients was 80% compared to 78% of the non-metabolic indications. The bad survival in WЈd and NHC is explained by the presentation as fulminant liver failure. Relaps of the metabolic disease was observed in 1 patient after LRLTX in PFIC2. Metabolic cure was achieved in patients with PFIC3, CRNA, a1-ATD, NHC, UCD and GSD IV. In some patients the metabolic cure was only partial but still there was a good quality of life CF: diabetes m., PFIC 2: diarrhea(n ϭ 1), WЈd (n ϭ 1) and Ty I (n ϭ 1: tubulopathy). In hyperoxaluria I, preemptive LTX prevented kidney transplantation in 3 out of 4 patients. The post-op course in patients with HCC (incidental finding after hepatectomy n ϭ 1, detected before LTX (n ϭ 1) was uneventful in both children. As far as quality of life is concerned, there was a dramatic improvement in patients with PFIC2 and 3 with regard to itching, no need of further phototherapy in patients with CRNA or dietary restrictions in UCD. In LRLTX there was no morbidity related to liver metabolism in the donors and no impaired metabolism in the recipients. Conclusion: Liver transplantation in hepatic based metabolic disorders is very effective. Survival rates are comparable to nonmetabolic indications. Even LRLTX may be considered since our data show phenotypic cure in all and metabolic cure in 95% of patients. Quality of life improved significantly in all indications.
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
The Continuity of Nutrition Care Through Liver Transplantation
Nutrition in Clinical Care, 2001
A BSTRACT Recent advancements in pharmacotherapies and medical technologies have significantly improved long-term survival rates after liver transplantation. However, as survival rates increase, so do incidences of other chronic diseases more commonly associated with advanced age. In fact, as a population, post-livertransplant patients are at greater risk for cardiovascular disease, diabetes mellitus, cancer, and osteoporosis than the general public. Moreover, disease risk factors such as hyperglycemia, dyslipidemia, hypertension, and excess weight gain continue to plague this population despite reduced-dose requirements for immunosuppressives-a class of drugs with numerous side effects-which, historically, were thought to contribute heavily to chronic disease risk. Thus, clinicians treating liver-transplant candidates are challenged to broaden the scope of their care to include prevention of other chronic diseases that may have strong nutritional components. Although nutrition and medical therapies should continue to treat specific symptoms associated with the stages of liver disease and transplantation, therapies and information provided to pre-transplant patients should include preventative measures to ensure optimal outcomes for improved longevity after transplant. The medical team should utilize the nutritional expertise of dietitians to lead this continuity of care through all stages of liver transplantation. To maximize longevity and quality of life, dietary intervention for chronic disease prevention should be implemented as soon as medically feasible. This paper reviews nutrition therapies for complications seen during liver transplantation and proposes individualized diet recommendations to be considered at the very earliest stages of caring for patients with liver disease. Nutr Clin Care. 2001;4:70-86