ABSTRACT
Transplantation ............................................................................................. 352 23.2.1 Nutritional Assessment ..................................................................... 354 23.2.2 Pretransplant Nutritional Support ..................................................... 355
23.3 Nutritional Support after Liver Transplantation ........................................... 357 23.3.1 Early Nutritional Support after Liver Transplantation ..................... 357
23.3.1.1 Acute Energy and Nutritional Requirements after Liver Transplant ................................................................. 357
23.3.1.2 The Donor Liver................................................................. 358 23.3.1.3 Nutritional Support after Liver Transplant ........................ 358
23.3.2 Long-Term Monitoring and Nutritional Support ..............................360 23.4 Summary Points ........................................................................................... 362 References .............................................................................................................. 362
Orthotopic liver transplantation (OLT) is a life-saving procedure for selected patients with end-stage liver disease (ESLD) and acute failure. In Spain, 8269 patients underwent OLT in the period 2000-2007, more than 700 of them in our unit. The main indications for OLT were cirrhosis of any etiology (59%), hepatic neoplasm (21%), chronic rejection in previous OLT (6%), and fulminant hepatic failure (3%) (Figure 23.1) [1]. The nutritional and metabolic derangements of candidates to OLT occurred before the surgical procedure, and malnutrition is common in patients with advanced liver disease. As far as the disease progresses, protein and caloric malnutrition is an established feature that increases the postoperative morbidity of these patients [2,3]. The interval between listing and transplantation, usually many months, provides a therapeutic window to institute nutritional management before the surgical procedure. Once it is performed, the liver transplantation recipient has a metabolic stress response similar to other major surgical procedures. The risk of nosocomial
infections related to immunosuppression or the secondary effects of these drugs enhance the need for establishing a nutritional program after transplantation. We can distinguish three different periods: (1) pretransplantation nutrition assessment and nutritional intervention; (2) acute postsurgical situation, where nutritional support is needed; and (3) follow-up period after recovery from the procedure when nutritional counseling and prevention of complications relating to immunosuppression are the recommended mode of the nutritional support.
