Malnutrition in children with chronic liver disease accepted for liver transplantation: Clinical profile and effect on outcome

Shepherd, Ross W.; Chin, Simon; Cleghorn, G. J.; Patrick, M.; Ong, T. H.; Lynch, S. V.; Balderson, Glenda A.; Strong, Russell W.

doi:10.1111/j.1440-1754.1991.tb02541.x

Cited by 97 publications

(69 citation statements)

References 8 publications

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“…Larger, prospective studies to examine PELD as a predictor of post-transplant outcomes are ongoing at this time. It is well accepted that young age at transplant and malnutrition impact outcomes in pediatric liver transplant recipients, especially those with biliary atresia (23,24). These parameters are included in the current PELD score.…”

Section: Discussionmentioning

confidence: 99%

Regional Variation and Use of Exception Letters for Cadaveric Liver Allocation in Children with Chronic Liver Disease

Salvalaggio¹,

Neighbors

Kelly

et al. 2005

American Journal of Transplantation

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The Pediatric End-Stage Liver Disease (PELD) score was designed to reduce subjectivity in liver allocation and to advantage patients with a higher probability of waiting list mortality. The aims of this study were to determine the impact of PELD implementation for children with chronic liver disease and to assess whether PELD met its goal of standardization of liver allocation for children. This study used data reported to the United Network for Organ Sharing (UNOS) registry for children with chronic liver disease receiving primary cadaveric liver transplant between January 2000 and December 2001 (pre-PELD) and March 2002 and July 2003 (PELD). PELD reduced the percentage of children transplanted while in an intensive care unit and as status 1. A calculated PELD score was used for allocation in only 52% of recipients. Thirty percent were status 1 at transplant and PELD scores granted by exception were used for allocation in 18% of patients. There was regional variation in PELD score at allocation and use of exception scores with a significant relationship between PELD score and percentage of exception cases. Regional variation suggests that PELD has not resulted in standardization of listing practices in pediatric liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Regional Variation and Use of Exception Letters for Cadaveric Liver Allocation in Children with Chronic Liver Disease

Salvalaggio¹,

Neighbors

Kelly

et al. 2005

American Journal of Transplantation

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“…Shepherd et al (1991), followed by Alonso (2008), observed that despite the intensive supply of calories, many children affected with cirrhosis and advanced chronic hepatitis fail to achieve normal growth, and their functions may continue to deteriorate, making transplantation the only possible solution.…”

Section: Discussionmentioning

confidence: 99%

“…If it failed to generate body weight gain, oral nutrition was integrated with cycles of enteral nutrition so as to reach the nutritional goals, administered via NG tube or gavage according to tolerance, and by gradually increasing formula volumes and concentrations. If the enteral route was not practicable, or if there was onset of complications, we administered parenteral nutrition (Holt, Miell, Jones, Mieli-Vergani, & Baker, 2000;Shepherd et al, 1991).…”

Section:  mentioning

confidence: 99%

Therapeutic Effectiveness of Nutrition Therapy in Pediatric Patients with Chronic Liver Diseases Awaiting Liver Transplantation

Giammanco¹,

Bavetta²,

Greco³

et al. 2013

JFR

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It is important to prevent protein/calorie malnutrition in children with end stage liver diseases prior to transplantation. This study involved 34 patients between the ages of 10 and 156 months (mean value 25.69 months  32.2) (13 females and 21 males) on the liver transplant waiting list. Data collected as of three months before transplant and up to ten months after the procedure concerned gender, age, weight, height, Pediatric End Stage Liver Disease Score, baseline pathology, type of nutrition, type of transplant, immunosuppression, pulse steroid therapy, length of stay, and post transplant complications. Linear regression analysis showed that the length of hospital stay was 24.5 days more for females than for males, but also that intensive nutrition therapy shortens this stay for both female patients (P = 0.085) and younger patients (P = 0.023). The study population was divided into two groups according to the different nutritional therapies adopted. The Student's t-test and Mann-Whitney test evidenced that the group receiving intensive nutrition therapy grew taller compared with the group following an oral diet (mean -1.37 and Prob = 0.043); that females grew taller compared to males (mean -1.65 +/-0.56); and that there was an increase in height among the children in the group receiving intensive nutrition therapy despite the presence (-1.37 +/-0.56) or absence (-14.8 +/-5.44 and Prob = 0.035) of complications, and despite the administration (-1.03 +/-0.33) or non administration (-1.48 +/-0.55 and Prob = 0.019) of steroids. Intensive nutrition therapy enhances the velocity of growth in height and shortens the length of hospital stay, thus optimizing the final prognosis of the baseline pathology.

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“…Better-nourished children have decreased mortality, a lower infection risk and fewer post-operative surgical complications. [11][12][13] Particular attention is also paid to immunisation. If feasible, live vaccines are administered before transplantation (varicella with measles, mumps and rubella, if aged >6 months) and caregivers are given advice on completing other vaccines, such as pneumococcal and hepatitis A and B.…”

Section: Waiting Period and Pre-transplantation Carementioning

confidence: 99%

Selection and work-up for liver transplantation

Zuckermann

Loveland

2012

S Afr Med J

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The primary goal of evaluating patients for liver transplantation (LT) is to identify appropriate candidates and establish a pre-transplantation plan. Prospective patients must first be referred to a transplantation centre for evaluation and, if deemed suitable, for work-up, with a view to being listed for transplantation. South Africa has centres offering LT in Johannesburg and Cape Town. Typically, referred patients are evaluated by a clinician, and further evaluations and tests are performed before the patient is discussed at a multidisciplinary transplantation meeting. Initiating the referral early in the course of disease facilitates improved outcomes, by allowing earlier LT before the establishment of end-stage disease. It is also well described that patients awaiting transplantation (and their families) demonstrate better psychological adaptation when the entire spectrum of issues is approached by a multidisciplinary clinical team.1 It is not uncommon for children to exhibit behavioural problems, depression, poor social adaptation and non-compliance after transplantation, which can be moderated by early counselling after referral. 2 Purpose and policyOrgan availability is the rate-limiting step regarding successful transplantation and a reduction in waiting-list mortality. This is particularly applicable in centres that do not have related living donor programmes, but rely solely on deceased donor organs. Consequently, the decision-making and selection process must be transparent, and a consistent set of evidence-based criteria must be applied to determine whether selection for transplantation is appropriate. IndicationsBorne out by our experience, approximately 50% of paediatric patients requiring LT have biliary atresia.2 However, the indications for LT fall into 5 major categories of liver disease: (i) cholestatic diseases; (ii) metabolic disorders; (iii) fulminant liver failure; (iv) auto-immune hepatitis; and (v) liver tumours. General listing criteriaInfants and children should be listed for LT when there is evidence that hepatic decompensation has occurred, is imminent, or is inevitable based on the natural history of the disease. Clinical endpoints that determine suitability for transplantation may include one or more of the following: severe cholestasis; portal hypertension with/without variceal bleeding; multiple episodes of ascending cholangitis; failure of hepatic synthetic function; malnutrition and failure to thrive; intractable ascites; encephalopathy; unacceptably poor quality of life due to liver disease; and life-threatening complications of stable liver disease, such as hepatopulmonary syndrome. Pre-LT assessment and work-upThe first step in evaluating a potential candidate for LT is to determine the severity and prognosis of the liver disease. A subjective clinical assessment is undertaken together with an objective assessment including comprehensive laboratory and radiological evaluations. The aim of this is to: (i) identify contra-indications that would either exclude LT, require dis...

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Malnutrition in children with chronic liver disease accepted for liver transplantation: Clinical profile and effect on outcome

Cited by 97 publications

References 8 publications

Regional Variation and Use of Exception Letters for Cadaveric Liver Allocation in Children with Chronic Liver Disease

Regional Variation and Use of Exception Letters for Cadaveric Liver Allocation in Children with Chronic Liver Disease

Therapeutic Effectiveness of Nutrition Therapy in Pediatric Patients with Chronic Liver Diseases Awaiting Liver Transplantation

Selection and work-up for liver transplantation

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