Nutrition assessment and its effect on various clinical variables among patients undergoing liver transplant

Abstract

Background: Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. Methods:We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Results: Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage , blood loss during the surgery, BIA (fat mass, FFM, muscle mass and body fat%). Conclusions:The different nutrition assessment tools showed great variability of results. SGA showed moderate agreement with phase angle of the body and was associated with various clinical and prognostic variables of liver transplantation.

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

“…The RR was 1.6 (95% CI 0.84‐3.03, I 2 54%) (forest plot not shown). Finally, 2 studies (both SGA) with 132 patients were meta‐analysed for PRBC utilisation, revealing a RR of 2.83 (95% CI 1.48‐4.19, I 2 0%), indicative of higher PRBC requirements for malnourished patients.…”

“…Forty-one articles met inclusion criteria 3,20-59 and were systematically evaluated, but of these, only 27 studies had data appropriate for meta-analysis. 3,[20][21][22][23][24][25]28,[34][35][36]38,[40][41][42][43][44][45][46][47][48][52][53][54]58,59 The search was repeated on February 14, 2018, restricted to articles published since August 5, 2017. Sixty-three further abstracts yielded 12 articles for full-text review and 6 articles which could be included in the study.…”

“…All studies: A total of 15 studies reported data on NATs in the prediction of post-transplant mortality. 21,[29][30][31]33,[35][36][37]41,45,49,51,52,56 In these studies, 32 NAT data points were evaluated and only nine (28%)…”

“…56 Meta-analysis: There were 6 studies with a total of 588 patients which investigated post-transplant mortality with data amenable to meta-analysis ( Figure S3). 21 Finally, a total of 3 studies assessed PRBC utilisation with 11 NAT data points and only 4 (36%) reported significant associations (see Table S6 for additional results).…”

Specific issues concerning the management of patients on the waiting list and after liver transplantation

“…The prevalence of malnutrition, sarcopenia and obesity is consistently high in studies on patients with cirrhosis on the waiting list for LT, albeit with a broad variability because of different diagnostic methods and criteria being used. Malnutrition develops in 20%‐90% of patients with cirrhosis, and sarcopenia in 40%‐70% of cases . The impact of obesity has been increasing in recent decades, reaching a prevalence of almost 35% among patients awaiting LT in the USA .…”