Nutritional Therapy in Liver Transplantation

Abstract

Protein-energy malnourishment is commonly encountered in patients with end-stage liver disease who undergo liver transplantation. Malnutrition may further increase morbidity, mortality and costs in the post-transplantation setting. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognized. The metabolic abnormalities induced by liver failure render the conventional assessment of nutritional status to be challenging. Preoperative loss of skeletal muscle mass, namely, sarcopenia, has a significant detrimental impact on post-transplant outcomes. It is essential to provide sufficient nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the needed energy intake. Herein, the latest currently employed perioperative nutritional interventions in liver transplant recipients are thoroughly illustrated including synbiotics, micronutrients, branched-chain amino acid supplementation, immunonutrition formulas, fluid and electrolyte balance, the offering of nocturnal meals, dietary counselling, exercise and rehabilitation.

Controlling Nutritional Status score does not predict patients' overall survival or hepatocellular carcinoma recurrence after deceased donor liver transplantation

“…The impact of LT on chronic inflammation and malnutrition is still under investigation. An increase in weight is actually commonly noted after LT, and it is usually clinically correlated with a greater dietary intake . However, this recovery usually results in a more robust gain of fat rather than lean body mass with sarcopenia persistence and frequent development of metabolic syndrome .…”

“…An increase in weight is actually commonly noted after LT, and it is usually clinically correlated with a greater dietary intake . However, this recovery usually results in a more robust gain of fat rather than lean body mass with sarcopenia persistence and frequent development of metabolic syndrome . Considering that the CONUT score is calculated on the basis of cholesterol and albumin plasma levels and lymphocyte count, it might be expected that it would tend to improve and normalize after an uncomplicated LT; this could potentially explain the lack of prognostic value of the pre‐LT CONUT score after LT.…”

Chronological changes in skeletal muscle mass following living‐donor liver transplantation: An analysis of the predictive factors for long‐term post‐transplant low muscularity

“…This period may last as long as 12 months, after which a compensatory recovery phase may develop . An increase in weight and BMI is actually commonly observed after LT . However, this recovery usually results in a more robust gain of fat mass, rather than skeletal muscle and lean body mass …”

“…The mainstay of therapy for malnutrition/sarcopenia is ensuring an adequate calories and protein intake and physical activity . EEF protocols aim to enhance the patient and graft recovery, counteracting the catabolic state induced by the surgical stress . Such protocols are also associated with a protective effect against postoperative infectious complications, by stimulating bile flow and portal blood flow, preventing intestinal mucosal atrophy, and preserving the intestinal structure and barrier function .…”

“…Unlike other cirrhosis-related complications that reverse after liver transplantation, sarcopenia may follow a different clinical course. [12][13][14] The reported data are limited and heterogeneous, but it seems that in the majority of transplanted patients, the immediate postoperative period is associated with a further reduction in lean body mass. 3,12,[14][15][16] This period may last as long as 12 months, after which a compensatory recovery phase may develop.…”