Topic Highlight
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2016; 22(4): 1513-1522
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1513
Nutrition therapy: Integral part of liver transplant care
Lucilene Rezende Anastácio, Maria Isabel Toulson Davisson Correia
Lucilene Rezende Anastácio, Nutrition Department, Universidade Federal do Triângulo Mineiro, Uberaba 38025-440, Brazil
Maria Isabel Toulson Davisson Correia, Department of Surgery, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais 31270-901, Brazil
Author contributions: Anastácio LR and Davisson Correia MIT wrote and review this article.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maria Isabel Toulson Davisson Correia, MD, PhD, Department of Surgery, Medical School, Universidade Federal de Minas Gerais, 110 Alfredo Balena Avenue, Santa Efigênia, Belo Horizonte, Minas Gerais 31270-901, Brazil. isabel_correia@uol.com.br
Telephone: +55-31-34094186 Fax: + 55-31-34094188
Received: April 28, 2015
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
Abstract

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.

Keywords: Nutritional status; Malnutrition; Obesity; Metabolic syndrome; Nutrition therapy; Liver transplantation

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.