Nutrition for the Liver Transplant Patient
Marina Yousri Saad;
Abstract
Summary
P
atients with end-stage liver disease (ESLD) frequently have diverse abnormalities of carbohydrate, lipid, and protein metabolism that cause progressive deterioration of their clinical condition and lead to malnutrition. Malnutrition is almost universally present in patients with ESLD undergoing liver transplantation and has been associated with increased morbidity and mortality. It is essential to identify and correct nutritional deficiencies in this population. Nutritional therapy is of documented value in those with malnutrition who are failing to maintain an adequate oral nutrient intake.
Generally, nutrition should be provided by the oral or the enteral route. Parenteral nutrition should only be used when enteral feeding is not possible or impractable. For parenteral nutrition energy should be provided by glucose and fat in a ratio of 65-50 : 35-50% of non-protein calories. Parenterally administered fat is cleared from the blood and utilized efficiently by the majority of patients with cirrhosis. MCT/LCT emulsions are well tolerated in transplanted patients. As a standard, nitrogen should be provided by conventional amino acid solutions for parenteral nutrition or high quality protein for enteral feeding in amounts to meet requirements of the patients.
Recommendations for various clinical conditions are achieving an adequate nitrogen intake. Vegetable protein can also be tried, but the risk of inadequate protein assimilation should be kept in mind. Patients in coma (encephalopathy III-IV °) can safely be given TPN regimens providing 25-30 kcal-kg-t.d non protein energy plus 1.0 g.kg.d 1 using BCAA-enriched amino acid solutions.
It also seems advantageous to administer postoperative nutrition to patients undergoing major surgery, including transplantation.Fasting periods should not exceed 6 h due to the limited glycogen stores in malnourished cirrhotic patients.
The main purpose of nutritional support in the immediate posttransplant phase is to correct nutritional deficiencies. However, prevention is the main target of chronic nutritional therapy after liver transplantation. Several metabolic complications such as diabetes mellitus hypercholesterolemia, obesity, and hypertension are common in patients after LT. This metabolic syndrome contributes to patient morbidity and mortality and should be manged wisely.
P
atients with end-stage liver disease (ESLD) frequently have diverse abnormalities of carbohydrate, lipid, and protein metabolism that cause progressive deterioration of their clinical condition and lead to malnutrition. Malnutrition is almost universally present in patients with ESLD undergoing liver transplantation and has been associated with increased morbidity and mortality. It is essential to identify and correct nutritional deficiencies in this population. Nutritional therapy is of documented value in those with malnutrition who are failing to maintain an adequate oral nutrient intake.
Generally, nutrition should be provided by the oral or the enteral route. Parenteral nutrition should only be used when enteral feeding is not possible or impractable. For parenteral nutrition energy should be provided by glucose and fat in a ratio of 65-50 : 35-50% of non-protein calories. Parenterally administered fat is cleared from the blood and utilized efficiently by the majority of patients with cirrhosis. MCT/LCT emulsions are well tolerated in transplanted patients. As a standard, nitrogen should be provided by conventional amino acid solutions for parenteral nutrition or high quality protein for enteral feeding in amounts to meet requirements of the patients.
Recommendations for various clinical conditions are achieving an adequate nitrogen intake. Vegetable protein can also be tried, but the risk of inadequate protein assimilation should be kept in mind. Patients in coma (encephalopathy III-IV °) can safely be given TPN regimens providing 25-30 kcal-kg-t.d non protein energy plus 1.0 g.kg.d 1 using BCAA-enriched amino acid solutions.
It also seems advantageous to administer postoperative nutrition to patients undergoing major surgery, including transplantation.Fasting periods should not exceed 6 h due to the limited glycogen stores in malnourished cirrhotic patients.
The main purpose of nutritional support in the immediate posttransplant phase is to correct nutritional deficiencies. However, prevention is the main target of chronic nutritional therapy after liver transplantation. Several metabolic complications such as diabetes mellitus hypercholesterolemia, obesity, and hypertension are common in patients after LT. This metabolic syndrome contributes to patient morbidity and mortality and should be manged wisely.
Other data
| Title | Nutrition for the Liver Transplant Patient | Other Titles | التغذية لمريض زرع الكبد | Authors | Marina Yousri Saad | Issue Date | 2016 |
Recommend this item
Similar Items from Core Recommender Database
Items in Ain Shams Scholar are protected by copyright, with all rights reserved, unless otherwise indicated.