title: Child-Pugh class, nutritional indicators and early liver transplant outcomes.
abstract: OBJECTIVE
  Patients with chronic liver disease undergoing liver transplantation have reduced body fat and muscle mass. The extent to which nutritional indicators and Child-Pugh class are predictive of postoperative outcome 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-Pugh class and disease type. This study included 80 patients (1990-1994).
  
  
  METHODS
  The nutritional indicators utilized were grip strength, triceps 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 patients required longer ventilation and spent more time in the intensive care unit than Child-Pugh classes A and B. No significant relationships were found for length of hospital stay. Relationships between the nutritional indicators (when controlled for Child-Pugh class) and early morbidity could not be determined due to insufficient data. No relationship was established between 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-Pugh classes B and C. Parenchymal liver disease was associated with lower grip strength and mid-arm muscle area when compared to cholestatic disease.
  
  
  CONCLUSIONS
  Child-Pugh class C is associated with greater early postoperative morbidity. Advanced Child-Pugh class is also associated with diminished muscle status and parenchymal disease.
authors.affiliation: Nutrition Services, Princess Alexandra Hospital, Brisbane, Australia 4102.
authors.forename: W J
authors.initials: WJ
authors.lastname: Abbott
authors.forename: A
authors.initials: A
authors.lastname: Thomson
authors.forename: C
authors.initials: C
authors.lastname: Steadman
authors.forename: M L
authors.initials: ML
authors.lastname: Gatton
authors.forename: C
authors.initials: C
authors.lastname: Bothwell
authors.forename: P
authors.initials: P
authors.lastname: Kerlin
authors.forename: D R
authors.initials: DR
authors.lastname: Wall
authors.forename: S V
authors.initials: SV
authors.lastname: Lynch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D017093:Liver Failure / Q000145:classification / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D018570:Risk Assessment; D012885:Skinfold Thickness