Nutritional status: its influence on the outcome of patients undergoing liver transplantation

Merli, Manuela; Giusto, M.; Gentili, F.; Novelli, G.; Ferretti, G.; Riggio, Oliviero; Corradini, Stefano Ginanni; Siciliano, M.; Farcomeni, Alessio; Attili, Adolfo Francesco; Berloco, P.B.; Rossi, Massimo

doi:10.1111/j.1478-3231.2009.02135.x

Cited by 255 publications

(205 citation statements)

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“…4,5 Notably, the latter aspect could have been responsible of the difference between our findings and the results reported by previous meta-analyses as concerns the mortality risk. In fact, we found a pretty robust increase in OR at 30 days, when either BMI ≥30 and 40 were evaluated (1.90; CI: 1.38, R E F E R E N C E S 1 and prevention of relapse following surgery in Crohn's disease, 2 although its efficacy in the induction and maintenance of remission in Crohn's disease remains disputed.…”

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Editorial: liver transplantation in patients with non‐alcoholic fatty liver disease and obesity—authors’ reply

Barone

Viggiani

Losurdo

et al. 2017

Aliment Pharmacol Ther

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2.62), and, at lesser extent, at 5 years only for patients with a BMI ≥40 (1.34; CI: 1.08, 1.67). Moreover, we found higher rates of postoperative and cardiopulmonary complications in those with a BMI ≥30 (OR=1.60; CI: 1.21, 2.11 and OR=2.62; CI: 1.35, 5.09, respectively).However, we agree that the study findings raise two main issues: comorbidities such as diabetes and hypertension, instead of obesity itself, could have been responsible for the worsening of early and longterm post-transplant outcomes. In this perspective, it would have been interesting to know the causes of long-term post-transplant mortality.Unfortunately, this information is rarely reported in the studies. The other argument to be debated is the concurrence of many other factors, in addition to obesity, which could influence post-operative outcomes, including donor related factors, a longer permanence on the waiting list of obese patients and/or the selection bias between programmes for various thresholds of obesity. 6,7 Also in this case, we were aware of this limitation as outlined in the discussion. However, an exact estimate of the influence of obesity on post-operative outcomes would require that all data from primary studies should be adjusted for the same factors contributing to aggravate patients' outcome, an intrinsic limitation of which the meta-analytic approach suffers. 8At the end of our commentary, we want to take the opportunity to reaffirm the concept that BMI has several limitations (it does not take into account body composition, which is influenced by gender and age, as well as the increase in extracellular fluids), and in the future, new and more precise anthropometric parameters such as muscle mass and visceral fat should be taken in consideration as post-transplant risk factors. ACKNOWLEDG EMENTSThe authors' declarations of personal and financial interests are unchanged from those in the original article.2 460 |

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“…3 In addition, the drug may be of benefit in a subset of patients with irritable bowel syndrome. 4,5 Diverticular disease is a chronic disorder of the lower GI tract.…”

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Editorial: liver transplantation in patients with non‐alcoholic fatty liver disease and obesity—authors’ reply

Barone

Viggiani

Losurdo

et al. 2017

Aliment Pharmacol Ther

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“…Some studies suggest that a poor nutritional status, for instance, as reflected by the subjective global assessment, impairs posttransplantation outcomes (41)(42)(43). However, these measures are frequently considered as subjective (44).…”

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Systematic Review and Meta-Analysis of the Impact of Computed Tomography–Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation

Vugt

Levolger

Bruin

et al. 2016

American Journal of Transplantation

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“…78,94,95 Malnutrition is known to lead to glycogen depletion, and this has been suggested to result in increased plasma lactate: pyruvate ratios during the an hepatic phase and to favor the development of a post-operative systemic inflammatory response syndrome and multi-organ failure in these patients. 96 In a prospective study, Merli et al 97 presented data suggesting that malnutrition should be taken into account as a factor that increases both costs and post-transplant complications. Moreover, they demonstrated that malnutrition…”

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Nutrition in the Management of Cirrhosis and its Neurological Complications

Bémeur

Butterworth

2014

Journal of Clinical and Experimental Hepatology

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Nutritional status: its influence on the outcome of patients undergoing liver transplantation

Abstract: The present data suggest that recipients' malnutrition should be taken into account as a factor that increases complications and costs after LT.

Cited by 255 publications

References 33 publications

Editorial: liver transplantation in patients with non‐alcoholic fatty liver disease and obesity—authors’ reply

Editorial: liver transplantation in patients with non‐alcoholic fatty liver disease and obesity—authors’ reply

Systematic Review and Meta-Analysis of the Impact of Computed Tomography–Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation

Nutrition in the Management of Cirrhosis and its Neurological Complications

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