Dietitians' practices and perspectives on nutrition priorities for liver transplant recipients

Abstract

Aim: To describe current practice and priorities of dietitians during the acute (≤3 months) and long-term (≥6 months) management of liver transplant recipients. Methods: Ten liver transplant dietitians (10/14, 71%) in Australia, New Zealand, UK and USA responded to an online survey. The survey graded nutrition priorities on a Likert scale, recorded barriers to service delivery and workforce allocation for nutrition services (ratio of full-time equivalent: annual transplant rate). Results: Just over half (n = 6, 60%) reported routine dietary assessment post-liver transplant. The majority (90%, n = 9) also provide initial dietary education in the acute setting. Thirty percent (n = 3) routinely provide ongoing acute follow up; however, no sites provide routine follow up after 6 months. Dietitian-to-transplant patient ratios demonstrated a broad range of resource allocation across sites 1:244 (1:39-1:1410). 70% (n = 7) reported lack of funding as a major barrier. Protein and energy requirements (n = 10, 100%) were identified as the main clinical focus in the acute period. Prevention of post-transplant weight gain and diabetes were identified as priority areas during the acute period by 60% of respondents (n = 6) and long-term management by all respondents (n = 10, 100%). Conclusion: This international survey identified inconsistent resourcing of nutrition services post-liver transplantation, with lack of funding the main barrier to providing long-term care. While the majority of liver transplant dietitians prioritise prevention of excessive weight gain, long-term follow up is limited. Further research is needed to investigate the optimal management of liver transplant recipients.

Utilizing Technology for Diet and Exercise Change in Complex Chronic Conditions Across Diverse Environments (U-DECIDE): Protocol for a Randomized Controlled Trial

“…On a global scale, the MetS represents a substantial treatment burden due to increased costs and medication expenditure, hospitalization, and utilization of outpatient services [3,4]. The prevalence of the MetS is up to 60% in tertiary health care settings among patients with complex chronic conditions, including kidney and liver disease [5][6][7].…”

Incorporating digital platforms into nutritional care in chronic kidney disease

“…It has been shown that over 40% of kidney dietitians lack adequate time with patients and one in four feel that they do not have appropriate technology and administrative support to implement evidence‐based practice guidelines 11 . Furthermore, where services do exist, they are often fragmented, require individual appointments with multiple healthcare professionals, and are typically restricted to one‐on‐one, face‐to‐face consultations 12–14 . This approach is costly and inefficient and does not adequately meet patient's needs 12–14 …”

“…Furthermore, where services do exist, they are often fragmented, require individual appointments with multiple healthcare professionals, and are typically restricted to one‐on‐one, face‐to‐face consultations 12–14 . This approach is costly and inefficient and does not adequately meet patient's needs 12–14 …”

“…11 Furthermore, where services do exist, they are often fragmented, require individual appointments with multiple healthcare professionals, and are typically restricted to one-on-one, face-to-face consultations. [12][13][14] This approach is costly and inefficient and does not adequately meet patient's needs. [12][13][14] Given the rising disease prevalence, patient expectations, and over-stretched health systems, innovative solutions are needed to facilitate the delivery of efficient and effective kidney nutrition services.…”

“…[12][13][14] This approach is costly and inefficient and does not adequately meet patient's needs. [12][13][14] Given the rising disease prevalence, patient expectations, and over-stretched health systems, innovative solutions are needed to facilitate the delivery of efficient and effective kidney nutrition services. Alternate modalities of service delivery need to be low-cost, scalable, and maximize the potential of the existing clinical workforce to deliver effective patient-centered care.…”