Nutrition support following liver transplantation: comparison of jejunal versus parenteral routes.
Liver failure patients are chronically malnourished at the time of transplant. We have used jejunostomy tubes (j-tube) placed at the time of liver transplantation for immediate postoperative enteral nutrition. We compared the effectiveness of this means of nutrition to total parenteral nutrition (TPN). Sixty-three adult patients fed enterally (ENT) with a semi-elemental diet were retrospectively compared to 21 adult controls alimented with TPN, both beginning after liver transplantation. Data collected included: day to initiation of nutrition, day of achieving goal nutrition, day of removal of nasogastric tube, day of initiation of oral nutrition, day of achieving oral nutritional goal, and serum albumin, cholesterol, SGOT, SGPT, GGT, and bilirubin. Intestinal complications of diarrhea, ileus, and perforation were analyzed. Statistical analyses used an unpaired t-test for continuous data, and Chi square for categorical data. Caloric requirements, percentage ideal body weight, age, and initial cholesterol and albumin were equal. Fifty-four of the ENT patients were fed only by j-tube; 9 ENT patients also required TPN. ENT patients started on nutrition sooner (3 +/- 1.7 vs. 1.7 +/- 0.9 days, p = 0.001), reached goal oral nutrition sooner (19.5 +/- 11 days vs. 38.6 +/- 24.6 days, p = 0.0061, Mann-Whitney U test), and had a lower frequency of prolonged postoperative ileus (8.3%, vs. 33%, p = 0.009) than TPN patients. ENT patients had a greater frequency of diarrhea than TPN controls (73% vs. 25%, p < 0.001). This diarrhea was self-limited, lasting 3 to 5 days, and responded to anti-motility drugs.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Surgery, Indiana University, Indianapolis, USA.
P L
PL
Mehta
K J
KJ
Alaka
R S
RS
Filo
S B
SB
Leapman
M L
ML
Milgrom
M D
MD
Pescovitz
D000328:Adult; D004750:Enteral Nutrition; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007582:Jejunostomy; D017093:Liver Failure / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000628:therapy*; D011502:Protein-Energy Malnutrition / Q000628:therapy*; D016896:Treatment Outcome