IDENTIFICATION OF HIGH-RISK AND LOW-RISK PATIENTS BEFORE LIVER-TRANSPLANTATION - A PROSPECTIVE COHORT STUDY OF NUTRITIONAL AND METABOLIC PARAMETERS IN 150 PATIENTS

The clinical relevance of malnutrition and hypermetabolism in end-stag e liver disease, as well as their effects on survival after liver tran splantation (LTx), are largely unknown. This study investigates the pr ognostic value of nutritional and metabolic parameters obtained before LTx for survival after LTx. One hundred fifty patients with end-stage liver disease undergoing LTx were assessed prospectively and followed for a mean period of 46 +/- 16 months after LTx. All patients were ra ndomized into a study group and a validation group, each comprising 75 patients. Body composition analysis (24-hour urinary creatinine excre tion, anthropometry, bioelectrical impedance analysis), deviation of m easured hom predicted resting energy expenditure (Delta REE), year of transplantation, and several variables known to be of prognostic relev ance in patients with Liver disease undergoing conservative treatment were analyzed. Kaplan-Meier and log rank. analysis showed that hyperme tabolic patients (Delta REE > +20%) and patients with a body cell mass (BCM) < 35% of body weight tended to have reduced survival after LTx. A risk profile on the basis of Delta REE and BCM identified patients with high risk (5-year survival rate, 54%) and low risk (5-year surviv al rate, 88%; P < .01). The predictive power of this risk profile was independent of the presence of ascites and clinical edema, and its val idity was confirmed in the validation group (P < .01). The Child-Pugh score was not of prognostic value. We conclude that a poor nutritional state, as well as hypermetabolism, adversely affects survival after L Tx. These potentially treatable presurgical factors deserve close atte ntion in interventional studies.