Nutritional interventions for liver-transplanted patients

Langer, Gero; Großmann, Katja; Fleischer, Steffen; Berg, Almuth; Grothues, Dirk; Wienke, Andreas; Behrens, Johann; Fink, Astrid

doi:10.1002/14651858.cd007605.pub2

Cited by 30 publications

(27 citation statements)

References 70 publications

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“…In contrast, the other centers that published data on a loss of lean body mass did not report on posttransplant exercise or specific nutritional recommendations. A number of studies have examined the impact of nutritional interventions on the immediate postoperative period [47]. The Cochrane review did not find any benefit of nutritional interventions in the immediate postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Posttransplant Sarcopenia: An Underrecognized Early Consequence of Liver Transplantation

Dasarathy

2013

Dig Dis Sci

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Liver transplantation is believed to reverse the clinical and metabolic abnormalities of cirrhosis. Reduced skeletal muscle mass or sarcopenia contributes to increased mortality and adverse consequences of cirrhosis. Failure of reversal of sarcopenia of cirrhosis after liver transplantation is not well recognized. Six temporally, geographically, and methodologically distinct follow-up studies in 304 cirrhotics reported conflicting data on changes in indirect measures of skeletal muscle mass after transplantation. Distinct measures of body composition but not skeletal muscle mass were used and did not focus on the clinical consequences of sarcopenia after transplantation. A number of studies reported an initial rapid postoperative loss of lean mass followed by incomplete recovery with a maximum follow-up of 2 years. Posttransplant sarcopenia may be responsible for metabolic syndrome and impaired quality of life after liver transplantation. Potential reasons for failure to reverse sarcopenia after liver transplantation include use of immunosuppressive agents [mammalian target of rapamycin (mTOR) and calcineurin inhibitors] that impair skeletal muscle growth and protein accretion. Repeated hospitalizations, posttransplant infections, and renal failure also contribute to posttransplant sarcopenia. Finally, recovery from muscle deconditioning is limited by lack of systematic nutritional and physical-activity-based interventions to improve muscle mass. Despite the compelling data on sarcopenia before liver transplantation, the impact of posttransplant sarcopenia on clinical outcomes is not known. There is a compelling need for studies to examine the mechanisms and consequences of sarcopenia post liver transplantation to permit development of therapies to prevent and reverse this disorder.

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Section: Discussionmentioning

confidence: 99%

Posttransplant Sarcopenia: An Underrecognized Early Consequence of Liver Transplantation

Dasarathy

2013

Dig Dis Sci

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“…Nutritional interventions in the peri-operative time period have not demonstrated any benefits [148]. As the greatest weight gain occurs in the first year following LT [100], the dietary interventions should be implemented early after LT following the recommendations of specific guidelines for the management of overweight and obesity [149].…”

Section: How To Optimize the Outcome Of Nafld Patients Undergoing Ltmentioning

confidence: 99%

NAFLD and liver transplantation: Current burden and expected challenges

Pais

Barritt

Calmus

et al. 2016

Journal of Hepatology

370

315

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Summary Because of global epidemics of obesity and type 2 diabetes, the prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing both in Europe and the United States, becoming one of the most frequent causes of chronic liver disease and predictably, one of the leading causes of liver transplantation both for end-stage liver disease and hepatocellular carcinoma. For most transplant teams around the world this will raise many challenges in terms of preand post-transplant management. Here we review the multifaceted impact of NAFLD on liver transplantation and will discuss: (1) NAFLD as a frequent cause of cryptogenic cirrhosis, end-stage chronic liver disease, and hepatocellular carcinoma; (2) prevalence of NAFLD as an indication for liver transplantation both in Europe and the United States; (3) the impact of NAFLD on the donor pool; (4) the access of NAFLD patients to liver transplantation and their management on the waiting list in regard to metabolic, renal and vascular comorbidities; (5) the prevalence and consequences of post-transplant metabolic syndrome, recurrent and de novo NAFLD; (6) the alternative management and therapeutic options to improve the long-term outcomes with particular emphasis on the correction and control of metabolic comorbidities.

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“…Assessment and counseling by a dietician is an integral part of the evaluation process, including correcting misconceptions about restriction of protein and addressing the possible need for enteral or even parental feeding prior to LT . However, a recent Cochrane Review was unable to identify benefit from nutritional support in LT candidates . With the increasing prominence of NAFLD as an indication for LT, many candidates have features of the metabolic syndrome resulting in the development of posttransplant diabetes mellitus .…”

Section: Introductionmentioning

confidence: 99%

Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation

et al. 2014

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Nutritional interventions for liver-transplanted patients

Abstract: We were unable to identify nutritional interventions for liver transplanted patients that seemed to offer convincing benefits. Further randomised clinical trials with low risk of bias and powerful sample sizes are needed.

Cited by 30 publications

References 70 publications

Posttransplant Sarcopenia: An Underrecognized Early Consequence of Liver Transplantation

Posttransplant Sarcopenia: An Underrecognized Early Consequence of Liver Transplantation

NAFLD and liver transplantation: Current burden and expected challenges

Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation

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