Nutritional aspects of liver transplantation

Current Opinion in Clinical Nutrition and Metabolic Care

Volumn 5, Issue 3, 2002, Pages 297-307

  Campos, Antonio C L ^a,b   Matias, Jorge E F ^a   Coelho, Julio C U ^a  

^a FEDERAL UNIVERSITY OF PARANÁ   (Brazil)

^b Department of Surgery ^*  (Brazil)

Author keywords

[No Author keywords available]

Indexed keywords

ANTHROPOMETRIC PARAMETERS; BODY COMPOSITION; DIETARY INTAKE; ENTERIC FEEDING; GLUCOSE METABOLISM; HUMAN; LIPID METABOLISM; LIVER TRANSPLANTATION; MAJOR CLINICAL STUDY; METABOLIC DISORDER; METABOLIC RATE; NUTRITIONAL STATUS; ORGAN DONOR; ORGAN TRANSPLANTATION; PARENTERAL NUTRITION; POSTOPERATIVE CARE; PREOPERATIVE EVALUATION; PROTEIN METABOLISM; REVIEW; TOTAL PARENTERAL NUTRITION; ENERGY METABOLISM; LIVER; METABOLISM; NUTRITIONAL ASSESSMENT; NUTRITIONAL DISORDER; NUTRITIONAL REQUIREMENT; PREOPERATIVE CARE;

ENERGY METABOLISM; ENTERAL NUTRITION; HUMANS; LIVER; LIVER TRANSPLANTATION; NUTRITION ASSESSMENT; NUTRITION DISORDERS; NUTRITIONAL REQUIREMENTS; NUTRITIONAL STATUS; PARENTERAL NUTRITION; POSTOPERATIVE CARE; PREOPERATIVE CARE;

EID: 0036583213     PISSN: 13631950     EISSN: None     Source Type: Journal    
DOI: 10.1097/00075197-200205000-00010     Document Type: Review

References (53)

1. Lake JR. Changing indications for liver transplantation. Gastroenterol Clin North Am 1993; 22:213-229.
2. Busuttil RW, Seu P, Millis JM, et al. Liver transplantation in children. Ann Surg 1991; 213:48-57.
3. Di Cecco SR, Wieners EJ, Wiesner RH, et al. Assessment of nutritional status of patients with end-stage liver disease undergoing liver transplantation. Mayo Clin Proc 1989; 64:95-102.
4. Figueiredo FA, Dickson ER, Pasha TN, et al. Utility of standard nutritional parameters in detecting body cell mass depletion in patients with end-stage liver disease. Liver Transpl 2000; 6:575-581. In order to determine which of the traditional nutritional parameters correlate with BCM, several standard parameters were assessed in 69 sequential patients awaiting OLT. Most of the commonly measured nutritional parameters correlated poorly with BCM. Mid-arm muscle circumference and handgrip strength were the best predictors of depleted BCM in a multivariate analysis. These two parameters combined were able to identify BCM depletion with a sensitivity of 94% and a negative predictive value of 97% when handgrip strength was less than 30 kg and mid-arm muscle circumference less than 23 cm.
5. Aranda-Michel J. Nutrition in hepatic failure and liver transplantation. Curr Gastroenterol Rep 2001; 3:362-370. A comprehensive review article on etiologic factors and nutritional assessment of the protein-energy malnutrition status of the end-stage liver disease as well as on nutritional therapy goals for patients undergoing orthotopic liver transplantation.
6. Shaw BW Jr, Wood RP, Gordon RD, et al. Influence of selected patient variables and operative blood loss on six-month survival following liver transplantation. Semin Liver Dis 1985; 5:385-393.
7. Hasse JM, Nutritional implications of liver transplantation. Henry Ford Hosp Med J 1990; 38:235-240.
8. Lochs H, Plauth M. Liver cirrhosis: rationale and modalities for nutritional support - the European Society of Parenteral and Enteral Nutrition consensus and beyond. Curr Opin Clin Nutr Metab Care 1999; 2:345-349.
9. McCullough AJ, Raguso C. Effect of cirrhosis on energy expenditure. Am J Clin Nutr 1999; 69:1066-1068.
10. Muller MJ, Bottcher J, Selberg O, et al. Hypermetabolism in clinically stable patients with liver cirrhosis. Am J Clin Nutr 1999; 69:1194-1201.
11. Selberg O, Bottcher J, Tusch G, et al. Identification of high and low-risk patients before liver transplantation: a prospective cohort study of nutritional and metabolic parameters in 150 patients. Hepatology 1997; 25:652-657.
12. Deschenes M, Villeneuve JP, Dagenais M, et al. Lack of relationship between preoperative measures of the severity of cirrhosis and short-term survival after liver transplantation. Liver Transpl Surg 1997; 3:532-537.
13. Madden AM, Morgan MY. Resting energy expenditure should be measured in patients with cirrhosis, not predicted. Hepatology 1999; 30:655-664.
14. Scolapio JS, Bowen J, Stoner G, Tarrosa V. Substrate oxidation in patients with cirrhosis: comparison with others nutritional markers. J Parenter Enter Nutr 2000; 24:150-153. Malnutrition in patients with hepatic cirrhosis is associated with abnormal fuel metabolism marked by reduced glucose and increased lipid oxidation. In 15 cirrhotic patients awaiting OLT, the respiratory quotient, assessed by indirect calorimetry, was correlated with classic anthropometric nutritional parameters. The respiratory quotient did not correlate with any of the routine nutritional parameters, except for serum albumin and creatinine-height index, although the association was poor. Therefore, anthropometric measurements may suggest normal nutritional status while indirect calorimetry suggests abnormal fuel metabolism. Metabolic derangement In cirrhotic patients may precede rather than follow PEM.
15. Muller MJ, Pirlich M, Balks HJ, et al. Glucose intolerance in liver cirrhosis: role of hepatic and non-hepatic influences. Eur J Clin Chem Clin Biochem 1994; 32:749-758.
16. McCullough AJ, Tavill AS. Disordered energy and protein metabolism in liver disease. Semin Liver Dis 1991; 11:265-277.
17. Kondrup J, Nielsen K, Juul A. Effect of long-term refeeding on protein metabolism in patients with cirrhosis of the liver. Br J Nutr 1997; 77:197-212.
18. Cabré E, Gassull MA. Nutritional and metabolic issues in cirrhosis and liver transplantation. Curr Opin Clin Nutr Metab Care 2000; 3:345-354.
19. Cabré E, Periago JL, Abad A, et al. Plasma fatty acid profile in advanced cirrhosis: unsaturation deficit of lipid fractions. Am J Gastroenterol 1990; 85:1597-1604.
20. Cabré E, Periago JL, Abad A, et al. Polyunsaturated fatty acid deficiency in liver cirrhosis: its relation to associated protein-energy malnutrition (preliminary report). Am J Gastroenterol 1988; 83:712-718.
21. Ramaccioni V, Soriano HE, Arumugam R, Klish WJ. Nutritional aspects of chronic liver disease and liver transplantation in children. J Pediatr Gastroenterol Nutr 2000; 30:361-367. Children with chronic liver disease are at high risk for malnutrition, particularly when the liver disease is cholestatic and its onset is in infancy. This paper reviews the special characteristics of assessing nutritional status of children with chronic liver disease and the particularities of nutritional support before and after liver transplantation in the childhood.
22. Hasse J, Strong S, German MA, Liepa G. Subjective global assessment: alternative nutrition-assessment technique for liver-transplant candidates. Nutrition 1993; 9:339-343.
23. Naveau S, Belda E, Borotto E, et al. Comparison of clinical judgment and anthropometric parameters for evaluating nutritional status in patients with alcoholic liver disease. J Hepatol 1995; 23:234-235.
24. Novy MA, Shwarz KB. Nutritional considerations and management of the child with liver disease. Nutrition 1997; 13:177-184.
25. Pirlich M, Schutz T, Spachos T, et al. Bioelectrical impedance analysis is a useful bedside technique to assess malnutrition in cirrhotic patients with and without ascites. Hepatology 2000; 32:1208-1215.
26. Kyle UG, Genton L, Mentha G, et al. Reliable bioelectrical impedance analysis estimate of fat-free mass in liver, lung and heart transplant patients. J Parenter Enter Nutr 2001; 25:45-51. In this study a subgroup of 72 patients awaiting OLT had BIA and DEXA measurements of fat and fat-free masses in pre- and posttransplant periods. BIA data correlated well with DEXA values and was able to demonstrate fat and fat-free masses differences before and after liver transplantation. The use of BIA in these patients can improve the monitoring of nutritional status by allowing frequent and timely evaluation of body composition changes, which will help early intervention and adaptation of nutritional care of transplant patients.
27. Presta E, Wang J, Harrison GG, et al. Measurements of total body electrical conductivity: a new method of estimation of body composition. Am J Clin Nutr 1983; 37:735-739.
28. Fiore P, Merli M, Andreoli A, et al. A comparison of skinfold anthropometry and dual-energy X-ray absorptlometry for the evaluation of the body fat in cirrhotic patients. Clin Nutr 1999; 18:349-351.
29. Figueiredo F, Dickson ER, Pasha T, et al. Impact of nutritional status on outcomes after liver transplantation. Transplantation 2000; 70:1347-1352. Poor preoperative nutritional status has been reported to be associated with adverse outcomes after OLT. In this prospective study the relationship of a wide array of preoperative nutritional parameters with different postoperative outcomes such as survival, intensive care unit and hospital length of stay, transfusion requirements, infection, graft rejection and global resource utilization (as an index of cost) were investigated in 53 patients undergoing OLT. Despite minor statistical significant associations, neither survival nor global resource utilization were associated with any preoperative nutritional parameter. Therefore, adverse outcomes after OLT may be primarily determined by factors others than the preoperative nutritional status. However, the results may also suggest that preoperative nutritional support, which was offered to this malnourished population, was able to overcome the adverse effects of malnutrition on OLT outcomes.
30. Abbott WJ, Thomson A, Steadman C, et al. Child-Pugh: class, nutritional indicators and early liver transplant outcomes. Hepato-Gastroenterol 2001; 48:823-827. Early liver post-transplant outcomes such as 1-year survival, ventilator time, and intensive care unit and hospital lengths of stay were measured in 80 adult patients undergoing OLT. These parameters were correlated to nutritional indicators (handgrip strength, triceps skinfold thickness and uncorrected mid-arm muscle area) to determine the predictive value of such nutritional parameters on postoperative outcomes after OLT. Relationships between nutritional indicators, when controlled to Child-Pugh class, and early morbidity could not be determined due to insufficient data. No relationship was established between one-year survival Child-Pugh class or nutritional indicators.
31. Lendinghen V, Beau P, Mannant PR, et al. Early feeding or enterai nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study. Dig Dis Sci 1997; 42:536-541.
32. Campos ACL, Marchesini JB. Recent advances in the placement of tubes for enteral nutrition. Curr Opin Clin Nutr Metab Care 1999; 2:265-269.
33. Nompleggi DJ, Bonkovsky HL. Nutritional supplementation in chronic liver disease: an analytical review. Hepatology 1994; 19:518-533.
34. Gopalan S, Saran S, Sengupta R. Practicalities of nutrition support in chronic liver disease. Curr Opin Clin Nutr Metab Care 2000; 3:227-229.
35. McGhee RD, Henderson JM, Milikan WJ Jr, et al. Comparison of the effects of hepatic-aid and a casein modular diet on encephalopathy, plasma amino acids and nitrogen balance in cirrhotic patients. Ann Surg 1997; 197:288-293.
36. Welmann A, Kuse ER, Bechstein WO, et al. Perioperative parenteral and enteral nutrition for patients undergoing orthotopic liver transplantation: results of a questionnaire from 16 European transplant units. Transpl Int 1998; 11(suppl 1):S289-S291.
37. Le Cornu KA, McKiernan FJ, Kapadia AS, Neuberger JM. A prospective randomized study of preoperative nutritional supplementation in patients awaiting elective orthotopic liver transplantation. Transplantation 2000; 69:1364-1369. In this interesting study 82 listed candidates for OLT with mid-arm muscle circumference less than the 25th percentile were randomly assigned to receive enteral supplementation (750 kcal, 20 g protein and 33.5 g fat) in addition to conventional diet or conventional diet alone, until they were transplanted. Supplementation improved mid-arm muscle circumference and handgrip strength, but did not affect the outcome. Despite more deaths in the control group, the difference in overall survival between the groups was only marginally significant (P=0.075).
38. Hasse JM, Blue LS, Liepa GU, et al. Early enteral nutrition support in patients undergoing liver transplantation. J Parenter Enteral Nutr 1995; 19: 437-443.
39. Wicks C, Somasundaram S, Bjarnason I, et al. Comparison of enteral feeding and total parenteral nutrition after liver transplantation. Lancet 1994; 24:837-840.
40. Bower RH, Talamini MA, Sax HC, et al. Postoperative enteral versus parenteral nutrition: a randomized controlled trial. Arch Surg 1986; 12:1040-1045.
41. Moore FA, Feliciano DV, Andrassy RJ, et al. Early enteral feeding compared with parenteral reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992; 216:172-183.
42. Reilly J, Mehta R, Teperman I, et al. Nutritional support after liver transplantation: a randomized prospective study. J Parenter Enterai Nutr 1990; 14:386-391.
43. Driscoll DF, Palombo JD, Bistrian BR. Nutritional and metabolic considerations of the adult liver transplant candidate and organ donor. Nutrition 1995; 11:255-263.
44. Palombo JD, Burke PA, Moldawer LL, et al. Assessment of cytokine response in liver donors at the time of organ procurement and association with allograft function. J Am Coll Surg 1994; 179:209-219.
45. Clavien PA, Harvey PRC, Sanabria JR, et al. Lymphocyte adherence in the reperfused rat liver: mechanisms and effects. Hepatology 1993; 17:131-142.
46. Greig PD, Forster J, Superina RA, et al. Donor-specific factors predict graft function following liver transplantation. Transplant Proc 1990; 22:2072-2073.
47. McKeown CMB, Edwards V, Phillips UM, et al. Sinusoidal lining damage: the critical injury in cold preservation of liver allografts in the rat. Transplantation 1988; 46:178-191.
48. Lanir A, Jenkins RL, Caldwell C, et al. Hepatic transplantation survival: correlation with adenine nucleotide level in the donor liver. Hepatology 1988; 8:471-475.
49. Palombo JD, Pomposelli JJ, Hirschberg Y, et al. Glycolytic support of adenine nucleotides in rat liver flush-preserved with UW or Collins' II. Importance of donor nutritional status. 1989; 48:901-905.
50. Cywes R, Greig PD, Sanabria JR, et al. Effect of intraportal glucose infusion on hepatic glycogen content and degradation, and outcome in liver transplantation. Ann Surg 1992; 216:235-246.
51. Adam R, Reynes M, Bao YM, et al. Impact of glycogen content of donor liver in clinical liver transplantation. Transplant Proc 1993; 25:1536-1537.
52. Todo S, Demetris AJ, Makowka L, et al. Primary nonfunction of hepatic allografts with preexisting fatty infiltration. Transplantation 1989; 47:903-905.
53. Mor E, Klintmalm GB, Gonwa TA, et al. The use of marginal donors for liver transplantation, a retrospective study of 365 liver donors. Transplantation 1992; 53:383-386.