Malnutrition in liver transplant patients - Preoperative subjective globalassessment is predictive of outcome after liver transplantation

Background. Malnutrition is a common complication of end-stage liver diseas e. It is frequently not a priority of treatment before liver transplantatio n. The purpose of this study was to examine whether prospective preoperativ e nutritional assessment could predict resource utilization and outcome aft er liver transplantation. Methods. We retrospectively reviewed 109 sequential orthotopic liver transp lants performed at our center between July 1996 and May 1999. Ten patients with fulminant hepatic failure were excluded from the study, leaving 99 pat ients. Nutritional status was determined at the time of transplantation usi ng subjective global assessment. Wilcoxon rank sum test and rank analysis o f variance were used to analyze the data. Results are reported as median (interquartile range). A P value <0.05 was c onsidered significant. Results. Intraoperative transfusion requirements of packed red blood cells and cryoprecipitate was higher in the patients with severe malnutrition in comparison to the mild and moderate groups (severe v s. moderate, 5.5 +/-5.5 vs. 3.0 +/-6, P=0.026; vs. mild, 1.5 +/-3, P <0.000 1). The severe group required more fresh-fro. zen plasma intraoperatively t han the mild group (mild vs. severe, 0 +/-2 vs. 2 +/-6, P=0.0007; vs. moder ate, 1 +/-4, P=0.071). Patients in the severe group had longer postoperativ e lengths of stay compared with patients in the moderate and mild groups (s evere vs. moderate, 16 +/-9 days vs. 10 +/-5 days, P=0.0027; vs. mild, 9 +/ -8 days, P=0.0006). Conclusions. Subjective global assessment is an excellent independent predi ctor of outcome in patients undergoing liver transplantation. Severely maln ourished patients require more blood products during surgery and have prolo nged postoperative length of stay in hospital. Our data suggest that if nut ritional repletion is possible in patients with end-stage liver disease bef ore transplantation, patient outcomes could be improved.