Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1513
Peer-review started: May 6, 2015
First decision: June 2, 2015
Revised: July 8, 2015
Accepted: November 19, 2015
Article in press: November 19, 2015
Published online: January 28, 2016
Processing time: 267 Days and 9.3 Hours
Managing malnutrition before liver transplantation (LTx) while on the waiting list and, excessive weight gain/metabolic disturbances in post-surgery are still a challenge in LTx care. The aim of this review is to support an interdisciplinary nutrition approach of these patients. Cirrhotic patients are frequently malnourished before LTx and this is associated with a poor prognosis. Although the relation between nutritional status versus survival, successful operation and recovery after LTx is well established, prevalence of malnutrition before the operation is still very high. Emerging research has also demonstrated that sarcopenia pre and post-transplant is highly prevalent, despite the weight gain in the postoperative period. The diagnosis of the nutritional status is the first step to address the adequate nutritional therapy. Nutritional recommendations and therapy to manage the nutritional status of LTx patients are discussed in this review, regarding counseling on adequate diets and findings of the latest research on using certain immunonutrients in these patients (branched chain amino-acids, pre and probiotics). Nutrition associated complications observed after transplantation is also described. They are commonly related to the adverse effects of immunosuppressive drugs, leading to hyperkalemia, hyperglycemia and weight gain. Excessive weight gain and post-transplant metabolic disorders have long been described in post-LTx and should be addressed in order to reduce associated morbidity and mortality.
Core tip: Cirrhotic patients are frequently malnourished before liver transplantation (LTx) and this is associated with a poor prognosis. Emerging research has also demonstrated that sarcopenia pre and post-transplant is highly prevalent, despite the weight gain in the postoperative period. The diagnosis of the nutritional status is the first step to address the adequate nutritional therapy. Nutritional recommendations and therapy to manage the nutritional status of LTx patients are discussed in this review. Nutrition associated complications observed after transplantation is also described. Excessive weight gain and post-transplant metabolic disorders have long been described in post-LTx and should be addressed to reduce associated morbidity/mortality.