Impact of nutritional status on outcomes after liver transplantation

Background Poor preoperative nutritional status has been reported to be ass ociated with adverse outcomes after liver transplantation. Published data a re, however, conflicting, with methods of preoperative nutritional assessme nt and postoperative outcomes varying between studies. Methods. We prospectively studied the predictive value of preoperative nutr itional status for adverse outcomes after liver transplantation. Assessment of preoperative nutritional status included: body cell mass determination, subjective global assessment, anthropometry, handgrip dynamometry, biochem ical and amino acid profile, Child's score, and dual-energy x-ray absorptio metry. Death, intensive care unit (ICU) length of stay greater than or equa l to4 days, hospital length of stay greater than or equal to 15 days, blood usage greater than or equal to 36 U of blood products, infection, rejectio n, and global resource utilization (an index of cost) greater than the medi an were considered poor outcomes. Results. Fifty-three patients were studied. Longer ICU stay was associated with lower handgrip strength (P < 0,01) and lower aromatic amino acid level s (P < 0,01), Longer total hospital stay and the development of infections were associated with lower branched chain amino acid levels (P < 0,01 and < 0,001, respectively). Acute cellular rejection was associated with lower t otal body fat (P < 0,001) and higher triglyceride levels (P < 0,02), Neithe r death nor higher global resource utilization was associated with any preo perative nutritional parameter. Conclusions. Lower preoperative handgrip strength and branched chain amino acid levels are associated with longer ICU stays and increased likelihood o f posttransplant infections. In our program, in which nutritional support w as provided to potential recipients exhibiting malnourishment, none of the measured nutritional parameters were associated with mortality or greater g lobal resource utilization.