Child-Pugh class, nutritional indicators and early liver transplant outcomes

Background/Aims: Patients with chronic liver disease undergoing liver trans plantation have reduced body fat and muscle mass. The extent to which nutri tional indicators and Child-Pugh class are predictive of postoperative outc ome in adults is unclear. The aims of this study were to determine in adult patients undergoing transplant 1) the influence of preoperative Child-Pugh class and nutritional indicators on early transplant outcomes and one-year survival, 2) the relationship between nutritional indicators and Child-Pug h class and disease type. This study included 80 patients (1990-1994). Methodology: The nutritional indicators utilized were grip strength, tricep s skinfold thickness and uncorrected mid-arm muscle area. Measured outcomes were ventilator time, intensive care stay, postoperative hospital stay and one-year survival. Results: Early morbidity was determined in survivors. Child-Pugh class C pa tients required longer ventilation and spent more time in the intensive car e unit than Child-Pugh classes A and B. No significant relationships were f ound length of hospital stay. Relationships between the nutritional indicat ors (when controlled for Child-Pugh class) and early morbidity could not be determined due;to insufficient data. No relationship was established betwe en one-year survival and Child-Pugh class or the nutritional indicators. Grip strength and mid-arm muscle area were lower in the patients in Child-P ugh:classes B and C. Parenchymal liver disease was associated with lower gr ip strength and mid-arm muscle area when compared to cholestatic disease. Conclusions: Child-Pugh class C is associated with greater early postoperat ive morbidity. Advanced Child-Pugh class is also associated with diminished muscle status and parenchymal disease.