Resolving Malnutrition With Parenteral Nutrition Before Liver Transplant in Biliary Atresia

Wendel, Danielle; Mortensen, Melissa; Harmeson, Alisha; Shaffer, Michele L.; Hsu, Evelyn; Horslen, Simon

doi:10.1097/mpg.0000000000001798

Cited by 26 publications

(22 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because of malabsorption, regular monitoring and early supplementation of fat‐soluble vitamins is indicated in children with cholestatic liver disease. Children with chronic liver disease remain at high risk for malnutrition, and given the association between malnutrition and poor outcomes in pediatric chronic liver disease, practitioners should have a low threshold for starting supplemental nutrition either with enteral or parenteral nutrition …”

Section: Liver Diseasementioning

confidence: 99%

Malnutrition in Children With Chronic Disease

Larson‐Nath

Goday

2019

Nut in Clin Prac

View full text Add to dashboard Cite

Malnutrition occurs when nutrient intake does not meet the needs for normal body functions and as a consequence leads to alterations of growth and development in children. Chronic illness puts children at risk for developing malnutrition. Because of children's rapid periods of growth and development, early diagnosis, prevention, and management of malnutrition are paramount. The reasons for malnutrition in children with chronic disease are multifactorial and are related to the underlying disease and nonillness-associated factors. This review addresses the causes, evaluation, and management of malnutrition in pediatric congenital heart disease, chronic kidney disease, liver disease, and cystic fibrosis. (Nutr Clin Pract. 2019;34:349-358)

show abstract

Section: Liver Diseasementioning

confidence: 99%

Malnutrition in Children With Chronic Disease

Larson‐Nath

Goday

2019

Nut in Clin Prac

View full text Add to dashboard Cite

show abstract

“…In spite of calorically dense enteral formulas and modular supplements, often delivered via nasogastric tubes, it is not uncommon for patients to still not achieve satisfactory growth. On the other hand, two studies have now demonstrated that PN improves the nutritional status ( i.e ., mid-arm circumference and triceps skinfold thickness) of malnourished patients with BA on the transplant waitlist[5,6], underscoring the important role this therapy plays in the nutritional optimization of liver transplant candidates.…”

Section: Discussionmentioning

confidence: 99%

“…In spite of these efforts, many children with BA will fail to achieve the desired catch-up growth, and will ultimately be prescribed parenteral nutrition (PN). Although PN has been shown to improve the nutritional status of children with BA on the liver transplant waitlist[5,6], PN delivered though a central venous catheter (CVC) introduces a new set of risks to the patient, including mechanical, infectious, and metabolic complications. We sought to characterize infectious complications of PN, specifically central line-associated bloodstream infection (CLABSI) among children with BA on the liver transplant waitlist.…”

Section: Introductionmentioning

confidence: 99%

Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation

Triggs

Beer

Mokha

et al. 2019

WJH

View full text Add to dashboard Cite

BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children. Patients with biliary atresia (BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone, and parenteral nutrition (PN) may be indicated. While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation, less is known about the risks, particularly infectious, associated with this therapy among this specific group of patients. AIM To describe the incidence, microbiology, and risk factors of central line-associated bloodstream infection (CLABSI) among children with BA listed for liver transplantation. METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children’s Hospital from 2008 through 2015 ( n = 96). Patients with a central line for administration of PN ( n = 63) were identified and details of each CLABSI event were abstracted. We compared the group of patients who experienced CLABSI to the group who did not, to determine whether demographic, clinical, or laboratory factors correlated with development of CLABSI. RESULTS Nineteen of 63 patients (30%, 95%CI: 19, 43) experienced 29 episodes of CLABSI during 4800 line days (6.04 CLABSI per 1000 line days). CLABSI was predominantly associated with Gram-negative organisms (14/29 episodes, 48%) including Klebsiella spp., Enterobacter spp., and Escherichia coli . The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae . Gram-positive organisms (all Staphylococcus spp.) and fungus (all Candida spp.) comprised 9/29 (31%) and 6/29 (21%) episodes, respectively. No demographic, clinical, or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation. No clinical, demographic, or laboratory factor we tested emerged as an independent predictor of CLABSI. While our data did not show an impact of CLABSI on the short-term clinical outcome, it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization, unnecessary healthcare dollar expenditures, and may exact an opportunity cost, in terms of missed allograft offers.

show abstract

“…Mid upper arm circumference should be included as part of a detailed anthropometrical assessment, as it corrects for hepatosplenomegaly and ascites. 22,28 Delayed referral results in progressive malnutrition for multiple reasons including: poor oral intake, increased energy expenditure, malabsorption, chronic enteropathy, deterioration in hepatic synthetic function, infective complications and immunosuppression. 23 Nutritional rehabilitation is of utmost importance, as the nutritional status has a recognised effect on pre-and post-transplant mortality.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of paediatric liver transplant for biliary atresia

et al. 2019

View full text Add to dashboard Cite

Background: Despite the widespread use of Kasai Portoenterostomy (KPE) for biliary atresia, more than two thirds of these patients require liver transplant. Liver transplantation is not widely available in South Africa, and Wits Donald Gordon Medical Centre is one of two centres performing paediatric liver transplantation in the country, and the only centre performing living related donor transplants. Methods: A retrospective review was performed at the centre. Demographic data were collected, and tabulated. Survival analysis was performed using the Kaplan Meier method. Complication rates were categorised into biliary, vascular and enteric, and classified as early and late. Results: Sixty-seven first time liver transplants were performed for biliary atresia at WDGMC from 2005 to 2017. Sixtynine percent were female patients and thirty-one percent were male patients. Forty-eight percent of patients under the age of 5 years had a z-score of-2 or worse for mid upper arm circumference (MUAC). One year overall survival of the cohort is 84.5%, and overall graft survival is 82.9%. Overall mortality was 22%, with infection being the most common cause of death. Conclusion: Early referral of all patients with biliary atresia to a paediatric liver transplant centre is essential for early assessment of indications, and medical and nutritional optimisation of patients. Primary liver transplant should be considered for a select group of patients with unique clinical indications.

show abstract

Resolving Malnutrition With Parenteral Nutrition Before Liver Transplant in Biliary Atresia

Abstract: Children with ESLD and malnutrition who have failed enteral feeding may benefit from PN to improve and/or resolve malnutrition before liver transplant.

Cited by 26 publications

References 38 publications

Malnutrition in Children With Chronic Disease

Malnutrition in Children With Chronic Disease

Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation

Outcomes of paediatric liver transplant for biliary atresia

Contact Info

Product

Resources

About