IMPACT OF LIVER TRANSPLANTATION ON NUTRITIONAL STATUS OF CHRONIC LIVER DISEASE EGYPTIAN PATIENTS

Abstract

Over the past years, the role of nutrition as one of the most important factors that can influence overall mortality and morbidity in ESLD has been well understood and appreciated. Without any doubt, liver cirrhosis drives the patients to a catabolic state depriving them of essential nutrients through mechanisms that need to be well understood by attending physicians so that proper actions are taken. Identifying the patients that are approaching the state of malnutrition by simple and easily applied methods is necessary in order to provide nutritional support to those that need it the most. Correction of the nutrient deficit can improve the clinical outcome. Therefore, nutritional advice by dietitions and supplementation of nutrients through oral feeding, enteral feeding, and/or administration of specially designed formulae should be undertaken. The use of BCAA formulae in protein-intolerant patients and in severe cases of malnutrition has given hope, despite the dispute over them. Patients on the waiting list for liver transplantation often present with malnutrition, either undernutrition or obesity. Both these conditions impact on the outcome after transplantation. Nutrition intervention plays an important role in the management of these individuals, despite the many controversies on how to adequately nutritionally assess them and how to best treat them. There have been recent reports on the importance of specific nutrients such and prebiotics and probiotics, as well as BCAA supplements. Another key strategy that might help improve these patients’ nutritional status is the timing for the use of supplements with clear evidence that nocturnal meals positively impact on metabolism thus improving the catabolic state. The diagnosis of nutritional status varied according to the method used. Body mass index was less suitable for malnutrition detection. The nutritional indicators that best correlated with the severity criteria proposed by Child-Pugh were arm circumference, arm muscle circumference, arm muscle area and global assessment of nutritional status. From our study, we showed that most Egyptian patients with end stage liver disease were malnourished at the time of LT. liver transplantation could correct their malnutrition rapidly .and significantly on short time.