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Review
. 2017 Oct 16;9(10):1126.
doi: 10.3390/nu9101126.

Nutritional Therapy in Liver Transplantation

Ahmed Hammad  1   2 , Toshimi Kaido  3 , Vusal Aliyev  4 , Claudia Mandato  5 , Shinji Uemoto  6
Affiliations
Review

Nutritional Therapy in Liver Transplantation

Ahmed Hammad et al. Nutrients. .

Erratum in

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.

Keywords: branched-chain amino acids; immunonutrition; liver transplantation; nutraceuticals; nutritional intervention; sarcopenia; synbiotics.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Etiology of Malnutrition in End Stage Liver Disease. BEE: basal energy expenditure; IBD: inflammatory bowel disease; IGF1: insulin growth factor 1; IL6: interleukin-6; GI: gastrointestinal tract; GH: growth hormone; LD: liver disease; NS: nervous system; TNF-α: tumour necrosis factor alpha.
Figure 2
Figure 2
Assessment of nutritional status in End Stage Liver Disease Patients.
Figure 3
Figure 3
Amino Acids Altered in Liver Disease. The expected BCAAs/tyrosine ratio (Fisher’s ratio), should be 3.5:1; it falls to 1:1 in patients with end stage liver disease. * Essential amino acids.
Figure 4
Figure 4
Nutritional interventions before and after liver transplantation. BEE: basal energy expenditure; BCAA: branched chain amino acids; COH: carbohydrates; MCTs: mean chain triglycerides; LT: liver transplantation; POD: post operative day.
See this image and copyright information in PMC

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