Nutrition Assessment and Support of Organ Transplant Recipients

Abstract

Timely nutrition assessment and intervention in organ transplant recipients may improve outcomes surrounding transplantation. A pretransplant nutrition assessment should include a variety of parameters including physical assessment, history, anthropometric measurements, and laboratory tests. Malnutrition compromises posttransplant survival; prolonged waiting times worsen outcomes when patients are already malnourished. Severe obesity may decrease graft function and survival in kidney transplant recipients. In the pretransplant phase, nutritional goals include optimization of nutritional status and treatment of nutrition-related symptoms induced by organ failure. Enteral tube feeding is indicated for patients with functional gastrointestinal tracts who are not eating adequately. Parenteral nutrition is rarely needed pretransplant except in cases of intestinal failure. When determining pretransplant nutrient requirements, nutritional status, weight, age, gender, metabolic state, stage and type of organ failure, malabsorption, induced losses, goals, and comorbid conditions must be considered. During the acute posttransplant phase, adequate nutrition is required to help prevent infection, promote wound healing, support metabolic demands, replenish lost stores, and perhaps mediate the immune response. Nutrient recommendations reflect posttransplant metabolic changes. The appropriateness of posttransplant nutrition support depends on the prevalence of malnutrition among patients with a specific type of organ failure and the benefits when nutrition support is given. Organ transplantation complications including rejection, infection, wound healing, renal insufficiency, hyperglycemia, and surgical complications require specific nutritional requirements and therapies. Many potential applications of nutrition in the pre- and posttransplant phases exist and require further study.

Nutritional Intervention in Heart Transplant Recipients – Dietary Recommendations

“…A comprehensive nutritional assessment of transplant recipients should include a variety of parameters including physical assessment, history, anthropometric measurements and laboratory tests (Hasse, 2001). This method has been used in subjects who were followed for four years.…”

“…Although BIA has become widely available, a single-frequency test may not be valid in transplant candidates due to body fluid shifts (Hasse, 2001). …”

“…The sum of various risk factors has a negative impact on survival (Almenar et al, 2005). In addition, malnutrition increases the risk of infection post transplant and may reduce survival (Hasse, 2001). …”

“…Osteoporosis is a leading cause of morbidity; the most rapid bone loss occurs during the first three months and in the first two years after cardiac transplantation (Hasse, 2001;Henderson et al, 1995).…”

“…Recommendations for specific levels of nutrients should be made after the following factors are considered: nutritional status, body weight, age, gender, metabolic state, stage and type of organ failure, presence of infection, malabsorption or induced losses, goals and comorbid conditions (Hasse, 2001). …”