Diet and nutrition therapy in pre-liver transplant patients

Abstract

Malnutrition is universally prevalent among pre-liver transplantation patients. Malnutrition among cirrhotic patients had been associated to increased morbidity and mortality rates. Also, severely malnourished patients before the transplant surgery have a higher rate of complications and a decreased overall survival rate after liver transplantation. In light of the high incidence of malnutrition and associated complications, it is essential to initiate treatment as early as it is assessed. This review addresses the aetiologies of malnutrition and appropriate treatment strategies to correct it in pre-liver transplant phase. Treatment should focus on maintaining nutrient intake and correcting various nutritional deficiencies. The dietician plays an integral role as part of the transplant team by providing appropriate nutrition therapy for solving various nutrition problems.

Keywords

End stage liver disease / liver transplantation / pre-liver transplant

References

[1] Kasper DL,Hauser S,Jameson JL.Harrison's Principles of Internal Medicine. 16th Ed.2005;New YorkThe McGraw-Hill Companies1301-2608

[2] Institute for Health Metrics and Evaluation (IHME). GBD Heatmap. Seattle, WA: IHME, University of Washington, 2013. Available from: http://vizhub.healthdata.org/irank/heat.php

[3] Cabre E,Abad-Lacruz A,Acero D,Xiol X.Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics..Gastroenterology1990;98:715-20

[4] McCullough AJ.Disordered energy and protein metabolism in liver disease..Semin Liver Dis1991;11:265-77

[5] Kondrup J.Energy and protein requirements of patients with chronic liver disease..J Hepatol1997;27:239-47

[6] Bathgate AJ,Sommerville D.The prediction of acute cellular rejection in orthotopic liver transplantation..Liver Transpl Surg1999;5:475-9

[7] Cabré E.Nutritional and metabolic issues in cirrhosis and liver transplantation..Curr Opin Clin Nutr Metab Care2000;3:345-54

[8] Cabré E.Nutritional aspects of chronic liver disease..Clin Nutr1993;12:S52-63

[9] Greco AV,Benedetti G,Tataranni PA.Daily energy and substrate metabolism in patients with cirrhosis..Hepatology1998;27:346-50

[10] Mendenhall CL,Weesner R,Goldberg SJ,Seeff LB,Tamburro C.VA cooperative study on alcoholic hepatitis II: prognostic significance or protein-calorie malnutrition..Am J Clin Nutr1986;43:213-8

[11] Abad A,Gonzalez Huix F.Influence of the nutritional status in the prognosis and clinical outcome of hospitalized patients with liver cirrhosis. Preliminary report..J Clin Nutr Gastroenterol1987;2:63-8

[12] Selberg O,Tusch G,Henkel E.Identification of high- and low-risk patients before liver transplantation. A prospective cohort study of nutritional and metabolic parameters in 150 patients..Hepatology1997;25:652-7

[13] Miki C,Mayer AD,Harrison JD,McMaster P.Energy storage and cytokine response in patients undergoing liver transplantation..Cytokine1999;11:244-8

[14] Riggio O,Merli M,Zullo A,Ziparo V,Fiaccadori F.Short-term oral zinc supplementation does not improve chronic hepatic encephalopathy. Results of a double-blind crossover trial..Dig Dis Sci1991;36:1204-8

[15] Newsome PN,Moussa Y,Poulopoulos G,Plevris JN.Low serum retinol levels are associated with hepatocellular carcinoma in patients with chronic liver disease..Aliment Pharmacol Ther2000;14:1295-301

[16] Lochs H.Liver cirrhosis: rationale and modalities for nutritional support-the European Society of Parenteral and Enteral Nutrition consensus and beyond..Curr Opin Clin Nutr Metab Care1999;2:345-9

[17] Bakshi N.Nutrition assessment in patients undergoing liver transplant..Indian J Crit Care Med2014;18:672-81 PMCID:PMC4195198

[18] Kleinberger G.Holm E.Energy supply during parenteral nutrition in liver insufficiency..Metabolism and nutrition in liver disease. 1st ed.1985;41st Falk Symposium303-12

[19] Shanbhogue RL,Jenkins RL,Benotti P.Resting energy expenditure in patients with end stage liver disease and in normal population..J Parenter Enteral Nutr1987;11:305-8

[20] Schneeweiss B,Ferenci P,Grimm G,Laggner AN,Kleinberger G.Energy metabolism in patients with acute and chronic liver disease..Hepatology1990;11:387-93

[21] Kleinberger G, Ferenci P, Riederer P, Thaler H. Advances in Hepatic Encephalopathy and Urea Cycle Diseases. Proceedings of 5th International Symposium on Ammonia, Semmering, Austria, May 1984. Basel: Karger Publication; 1984. pp. 674–81.

[22] Dolz C,Ibanez J,Mars P.Ascites increases the resting energy expenditure in liver cirrhosis..Gastroenterology1991;100:738-44

[23] Merli M,Servi R,De Santis A,Capocaccia L.Increased energy expenditure in cirrhotic patients with hepatocellular carcinoma..Nutrition1992;8:321-5

[24] Nielsen K,Dossing H,Kondrup J.Energy expenditure measured by the doubly labeled water method during hyperalimentation of patients with liver cirrhosis..J Hepatol1991;13:S151

[25] Campillo B,Sommer F,Fouet P.The thermogenic and metabolic effects of food in liver cirrhosis: consequences on the storage of nutrients and the hormonal counter regulatory response..Metabolism1992;41:476-82

[26] Muller MJ,Rieger A,Selberg O,Bürger M,von zur Mühlen A.Mechanism of insulin resistance associated with liver cirrhosis..Gastroenterology1992;102:2033-41

[27] Campillo B,Bonnet JC.Submaximal oxygen consumption in liver cirrhosis. Evidence of severe functional aerobic impairment..J Hepatol1990;10:163-7

[28] Muller MJ,Tettenborn M,Fichter J,Balks HJ,Selberg O.Metabolic, endocrine, haemodynamic and pulmonary responses to different types of exercise in individuals with normal or reduced liver function..Eur J Appl Physiol Occup Physiol1996;74:246-57

[29] Plevak DJ,Wiesner RH,Wahlstrom HE,Hammel KD.Nutritional support for liver transplantation: identifying caloric and protein requirements..Mayo Clin Proc1994;69:225-30

[30] Weimann A,Bechstein WO,Plauth M.Perioperative parenteral and enteral nutrition for patients undergoing orthotopic liver transplantation. Results of a questionnaire from 16 European transplant units..Transpl Int1998;11:S289-91

[31] Elwyn DH,Askanazi J.Energy expenditure in surgical patients..Surg Clin North Am1981;61:545-56

[32] De Ledinghen V,Mannant PR,Beau P,Borderie C,Silvain C.Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study..Dig Dis Sci1997;42:536-41

[33] Bories B.One-month regular oral nutrition in alcoholic cirrhotic patients. Changes of nutritional status, hepatic function and serum lipid pattern..Br J Nutr1994;72:937-46

[34] Naylor CD,Detsky AS.Parenteral nutrition with branched chain amino acids in hepatic encephalophathy. A meta-analysis..Gastroenterology1989;97:1033-42

[35] Bonkovsky HL,Jafri IH,Smith GS,Cotsonis GA.A randomized controlled trial of the treatment of alcoholic hepatitis with parenteral nutrition and oxandrolon II: short-term effects on nitrogen metabolism, metabolic balance and nutrition..Am J Gastroenterol1991;86:1209-18

[36] Swart GR,Vuure JK,Wattimena DL.Minimum protein requirements in liver cirrhosis determined by nitrogen balance measurements at three levels of protein intake..Clin Nutr1989;8:329-36

[37] Morgan M,Jennings G,Fuller NJ.Two-component models are of limited value for the assessment of body composition in patients with cirrhosis..Am J Clin Nutr2006;84:1151-62

[38] Nielsen BK,Martinsen L,Larsson B,Jensen MG.Long-term oral refeeding of patients with cirrhosis of the liver..Br J Nutr1995;74:557-67

[39] Khanna S.Role of branched-chain amino acids in liver disease: the evidence for and against..Curr Opin Nutr Metab Care2007;10:297-303

[40] Mardini HA,Record C.Amino acid challenge in patients with cirrhosis and control subjects: ammonia, plasma amino acid and EEG changes..Metab Brain Dis2006;21:1-10

[41] Bianchi G,Agostini F.Update on nutritional supplementation with branched-chain amino acids..Curr Opin Clin Nutr Metab Care2005;8:83-7

[42] Plauth M,Hamster W,Müller PH,Fürst P.Long-term treatment of latent portosystemic encephalopathy with branched-chain amino acids. A double-blind placebo-controlled crossover study..J Hepatol1993;17:308-14

[43] Marchesinin G,Merli M,Panella C,Rossi Fanelli F.Nutritional supplementation with branched chain amino acids in advanced cirrhosis: a double blind, randomized trial..Gastroenterology2003;124:1792-801

[44] Fukushima H,Ida E,Toda K,Sugiyama A,Tomita E.Nocturnal branched-chain amino acid administration improves protein metabolism in patients with liver cirrhosis: comparison with daytime administration..J Parenter Enteral Nutr2003;27:315-22

[45] Plauth M,Kondrup J,Ferenci P,ESPEN Consensus Group..ESPEN guidelines for nutrition in liver disease and transplantation..Clin Nutr1997;16:43-55

[46] Mizock BA.Nutritional support in hepatic encephalopathy..Nutrition1999;15:220-8

[47] Als-Nielsen B,Gluud LL.Branched-chain amino acids for hepatic encephalopathy..Cochrane Database Syst Rev2003;2:CD001939

[48] Muller MJ.Malnutrition in cirrhosis..J Hepatol1995;23 Suppl 1:31-5

[49] Leevy CM.Nutritional aspects of alcoholic liver disease..Clin Liver Dis2005;9:67-81

[50] Leo MA.Hepatic vitamin A depletion in alcoholic liver injury..N Engl J Med1982;307:597-601

[51] Hay JE.Evaluation and management of osteoporosis in liver disease..Clin Liver Dis2005;9:747-66

[52] Sainz J,Loro L,Roe TF.Vitamin D receptor gene polymorphisms and bone density in prepubertal American girls of Mexican descent..N Engl J Med1997;337:77-82

[53] Sharma R.Management of pre-liver transplantation patient: part 2..Liver Transpl2005;3:249-60

[54] Lochs H.Liver cirrhosis: rationale and modalities for nutritional support-the European Society of Parenteral and Enteral Nutrition consensus and beyond..Curr Opin Clin Nutr Metab Care1999;2:345-9

[55] Aggett PJ.Mills CF.Severe zinc defiency..Zinc in human biology.1989;BerlinSpringer259-74

[56] Raynard B,Fallik D,Bedossa P,Naveau S.Risk factors of fibrosis in alcohol-induced liver disease..Hepatology2002;35:635-8

[57] Bamgbade OA,Kheterpal S,Dorje P.Magnesium supplementation during liver transplantation..Internet J Surg2008;15:1

[58] Hasse JM.Nutritional implications of liver transplantation..Henry Ford Hosp Med J1990;38:235-40

[59] Hasse J.Role of the dietitian in the nutrition management of adults after liver transplantation..J Am Diet Assoc1991;91:473-6

[60] Hasse JM.Nutrition considerations in liver transplantation..Top Clin Nutr1992;7:24-33

[61] Munoz SJ.Nutritional therapies in liver disease..Semin Liver Dis1991;11:278-91

[62] Hasse JM,Crippin JS,Jennings LW,Husberg BS,Klintmalm GB.The effect of nutritional status on length of stay and clinical outcomes following liver transplantation..J Am Diet Assoc1994;94:A38

[63] Plauth M,Riggio O,Pirlich M,DGEM (German Society for Nutritional Medicine),Holm E,Müller MJ,ESPEN (European Society for Parenteral and Enteral Nutrition)..ESPEN guidelines on enteral nutrition: liver disease..Clin Nutr2006;25:285-94

[64] Sandu BS.Management of ascites in cirrhosis..Clin Liver Dis2005;9:715-32

[65] Ginés P,Bernardi M,Hamon G,Liard JF,Schrier RW.Hyponatremia in cirrhosis: from pathogenesis to treatment..Hepatology1998;28:851-64

[66] Runyon B,American Association for the Study of Liver Diseases (AASLD)..Management of adult patients with ascites due to cirrhosis..Hepatology2004;39:841-56

[67] Plauth M,Buckendahl DP,Pirlich M,Romaniuk P,Weiss ML.Weight gain after transjugular intrahepatic portosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism..J Hepatol2004;40:228-33

[68] Sheth AA.Probiotics and liver disease..J Clin Gastroenterol2008;42:S80-4

[69] Rayes N,Theruvath T,Langrehr JM,Bengmark S.Supply of pre and probiotics reduces bacterial infection rates after liver transplantation-a randomized, doubleblind trial..Am J Transplant2005;5:125-30

[70] Stadlbauer V,Hodges S,Davies NA.Effect of probiotic treatment on deranged neutrophil function and cytokine responses in patients with compensated alcoholic cirrhosis..J Hepatol2008;48:945-51

[71] Sharma P,Puri V.An open-label randomized controlled trial of lactulose and probiotics in the treatment of minimal hepatic encephalopathy..Eur J Gastroenterol Hepatol2008;20:506-11

[72] Bajaj JS,Christensen KM,Varma RR,Pleuss JA,Hoffmann RG.Probiotic yogurt for the treatment of minimal hepatic encephalopathy..Am J Gastroenterol2008;103:1707-15

[73] Tandon P,Madsen K,Owen RJ,Wong WW.Effects of probiotic therapy on portal pressure in patients with cirrhosis: a pilot study..Liver Int2009;29:1110-5

[74] Lata J,Pribramska V,Frič P,Stibůrek O.The effect of probiotics on gut flora, level of endotoxin and Child-Pugh score in cirrhotic patients: results of a double blind randomized study..Eur J Gastroenterol Hepatol2007;19:1111-3

[75] Plank LD,Gane EJ,Gillanders LK,Munn SR.Pre and postoperative immunonutrition in patients undergoing liver transplantation: a pilot study of safety and efficacy..Clin Nutr2005;24:288-96

[76] Qiu Y,Wang W,Ding Y.Nutrition support with glutamine dipeptide in patients undergoing liver transplantation..Transplant Proc2009;41:4232-7

[77] Plank LD,Peng S,Mathur S,McIlroy K,McCall JL.Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial..Hepatology2008;48:557-66

[78] Zillikens MC,Wattimena JL,Swart GR.Nocturnal oral glucose supplementation. The effects on protein metabolism in cirrhotic patients and in healthy controls..J Hepatol1993;17:377-83

[79] Stickel F,Schuppan D.Review article: nutritional therapy in alcoholic liver disease..Aliment Pharmacol Ther2003;18:357-73

[80] Halsted CH.Nutrition and alcoholic liver disease..Semin Liver Dis2004;24:289-304

[81] Hirsch S,De la Maza P,Petermann M,Gattas V.Controlled trial on nutrition supplementation in out-patients with symptomatic alcoholic cirrhosis..J Parenter Enteral Nutr1993;17:119-24

[82] Mendenhall CL,Roselle GA,Nemchausky BA,Schiff ER,Marsano LS.A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: results of a Department of Veterans Affairs cooperative study..Hepatology1993;17:564-76

[83] Le Cornu KA,Kapadia SA.A prospective randomized study of preoperative nutritional supplementation in patients awaiting elective orthotopic liver transplantation..Transplantation2000;69:1364-9

[84] Kawaguchi T,Itou M,Ibi R,Okada T,Otsuka M,Fujimoto K,Tanaka S,Sata M.Supplement improves nutrition and stresses caused by examination-associated fasting in patients with liver cirrhosis..Hepatol Res2008;38:1178-85

[85] Cabre E,Abad A,González J,Fernández-Bañares F,Gil A.Plasma fatty acid profile in advanced cirrhosis: unsaturation deficit of lipid fractions..Am J Gastroenterol1990;85:1597-604

[86] Cabre E.Nutrition in liver disease..Curr Opin Nutr Metab Care2005;8:545-51

[87] Hasse JM,Liepa GU,Jennings LW,Husberg BS,Gonwa TA.Early enteral nutrition support in patients undergoing liver transplantation..J Parenter Enteral Nutr1995;19:437-43

[88] Fan ST,Lai EC,Liu CL.Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma..N Engl J Med1994;331:1547-52

[89] Wicks C,Bjarnason I,Routley D,Tan KC.Comparison of enteral feeding and total parenteral nutrition after liver transplantation..Lancet1994;344:837-40

[90] DiCecco SR.Nutrition in alcoholic liver disease..Nutr Clin Pract2006;21:245-54

[91] Weimann A,Harsanyi L,Ljungqvist O,DGEM (German Society for Nutritional Medicine),Kemen M,Horbach T,Vestweber KH.ESPEN Guidelines on Enteral Nutrition: surgery including organ transplantation..Clin Nutr2006;25:224-44

[92] Plauth M,Campillo B,Marchesini G,Shenkin A,ESPEN..ESPEN guidelines on parenteral nutrition: hepatology..Clin Nutr2009;28:436-44