Page 216 - Read Online

Review

Diet and nutrition therapy in pre-liver transplant patients

Neha Bakshi, Kalyani Singh
Lady Irwin College, Department of Foods and Nutrition, University of Delhi, New Delhi 110001, India.

ABSTRACT
Malnutrition is universally prevalent among pre-liver transplantation patients. Malnutrition among cirrhotic patients
had been associated to increased morbidity and mortality rates. Also, severely malnourished patients before the
transplant surgery have a higher rate of complications and a decreased overall survival rate after liver transplantation.
In light of the high incidence of malnutrition and associated complications, it is essential to initiate treatment as
early as it is assessed. This review addresses the aetiologies of malnutrition and appropriate treatment strategies to
correct it in pre-liver transplant phase. Treatment should focus on maintaining nutrient intake and correcting various
nutritional deficiencies. The dietician plays an integral role as part of the transplant team by providing appropriate
nutrition therapy for solving various nutrition problems.
Key words: End stage liver disease; liver transplantation; pre-liver transplant

Corresponding Author:
Ms. Neha Bakshi, Lady Irwin College, Department of Foods and Nutrition, University of Delhi, Sikandra Road, Mandi House, New Delhi 110001,
India. E-mail: nehabakshi.9@gmail.com
Received: 30-01-2016, Accepted: 04-07-2016

INTRODUCTION CONSEQUENCES OF PREOPERATIVE MALNUTRITION
ON LIVER TRANSPLANTATION OUTCOME
Liver transplantation (LT) revolutionized the management of
liver disease. LT is the only option for those with end stage Survival in cirrhosis decreases according to the severity of
Preoperative hypermetabolism and body
[10,11]
malnutrition.
liver disease (ESLD). According to Institute of Health Metrics cell mass depletion was proven to be better predictors of
[1]
and Evaluation of Global Burden of Disease, deaths from the outcome of LT than the traditional Child-Pugh score.
[12]
cirrhosis in all age groups is ranked 12th globally and 19th in Undernutrition may induce an exaggerated cytokine
South Asia in 1990 and was ranked 12th globally and 11th in response favouring postoperative systemic inflammatory
South Asia in the year 2010. Hence, an increasing death from response syndrome and multi-organ failure in these
patients. Zinc deficiency is a precipitating factor for hepatic
[13]
cirrhosis is seen in South Asia over a period of time. [2]
encephalopathy. Deficiencies of water-soluble vitamins (B
[14]
and C) and fat soluble vitamins (A, E, D, and K) may occur
METABOLIC CHANGES IN ESLD in patients with cirrhosis which increases the susceptibility
of cell membranes to lipid peroxidation. Low retinol levels
[8]
Various metabolic changes that occur in ESLD patients are leads to an increased risk of developing hepatocellular
presented in Table 1 [3-7] which affect the nutrition state of carcinoma. [15]
pre-LT recipients. These factors are inadequate dietary
Hence, careful nutritional assessment of candidates for LT
intake, increased intestinal protein losses, malabsorption,
is very important because the nutritional status of these
low protein synthesis, hypermetabolism and disturbed patients may ultimately influence morbidity and mortality.
substrate utilization. [8,9] Unfortunately, no gold standard exists to determine the extent
of malnutrition in this population. An suitable nutritional
[16]
Access this article online
Quick Response Code This is an open access article distributed under the terms of the Creative
Website: Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
http://www.hrjournal.net/ others to remix, tweak, and build upon the work non-commercially, as long as the
author is credited and the new creations are licensed under the identical terms.
For reprints contact: service@oaepublish.com
DOI:
10.20517/2394-5079.2016.02 How to cite this article: Bakshi N, Singh K. Diet and nutrition therapy
in pre-liver transplant patients. Hepatoma Res 2016;2:207-15.
© 2016 Hepatoma Research | Published by OAE Publishing Inc. 207