title: Nutrition therapy: Integral part of liver transplant care.
abstract: Managing malnutrition before liver transplantation (LTx) while on the waiting list and, excessive weight gain/metabolic disturbances in post-surgery are still a challenge in LTx care. The aim of this review is to support an interdisciplinary nutrition approach of these patients. Cirrhotic patients are frequently malnourished before LTx and this is associated with a poor prognosis. Although the relation between nutritional status versus survival, successful operation and recovery after LTx is well established, prevalence of malnutrition before the operation is still very high. Emerging research has also demonstrated that sarcopenia pre and post-transplant is highly prevalent, despite the weight gain in the postoperative period. The diagnosis of the nutritional status is the first step to address the adequate nutritional therapy. Nutritional recommendations and therapy to manage the nutritional status of LTx patients are discussed in this review, regarding counseling on adequate diets and findings of the latest research on using certain immunonutrients in these patients (branched chain amino-acids, pre and probiotics). Nutrition associated complications observed after transplantation is also described. They are commonly related to the adverse effects of immunosuppressive drugs, leading to hyperkalemia, hyperglycemia and weight gain. Excessive weight gain and post-transplant metabolic disorders have long been described in post-LTx and should be addressed in order to reduce associated morbidity and mortality.
authors.affiliation: Lucilene Rezende Anastácio, Nutrition Department, Universidade Federal do Triângulo Mineiro, Uberaba 38025-440, Brazil.
authors.forename: Lucilene Rezende
authors.initials: LR
authors.lastname: Anastácio
authors.affiliation: Lucilene Rezende Anastácio, Nutrition Department, Universidade Federal do Triângulo Mineiro, Uberaba 38025-440, Brazil.
authors.forename: Maria Isabel Toulson
authors.initials: MI
authors.lastname: Davisson Correia
mesh_terms: D058625:End Stage Liver Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D044623:Nutrition Therapy / Q000009:adverse effects; D009752:Nutritional Status; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D007166:Immunosuppressive Agents
keywords: Liver transplantation; Malnutrition; Metabolic syndrome; Nutrition therapy; Nutritional status; Obesity
references.citation: Hepatology. 2015 Feb;61(2):639-47
references.pmid: 25212278
references.citation: Liver Transpl. 2012 Oct;18(10):1209-16
references.pmid: 22740290
references.citation: JPEN J Parenter Enteral Nutr. 1993 Mar-Apr;17(2):119-24
references.pmid: 8455312
references.citation: Gastroenterology. 1991 Mar;100(3):738-44
references.pmid: 1993495
references.citation: World J Gastroenterol. 2011 Feb 21;17(7):922-5
references.pmid: 21412501
references.citation: Diabetes Care. 2013 Jan;36 Suppl 1:S11-66
references.pmid: 23264422
references.citation: Nutrition. 2015 Jan;31(1):105-10
references.pmid: 25441593
references.citation: Clin Nutr. 2006 Apr;25(2):285-94
references.pmid: 16707194
references.citation: Q J Med. 1989 Aug;72(268):737-47
references.pmid: 2602555
references.citation: Liver Transpl Surg. 1998 Jul;4(4):285-96
references.pmid: 9649642
references.citation: Gastroenterology. 1970 Nov;59(5):657-64
references.pmid: 5475122
references.citation: Dig Dis Sci. 2013 Nov;58(11):3103-11
references.pmid: 23912247
references.citation: Clin Nutr. 2009 Aug;28(4):436-44
references.pmid: 19520466
references.citation: Endocrinol Metab Clin North Am. 2007 Dec;36(4):873-90; vii
references.pmid: 17983926
references.citation: Am J Transplant. 2012 Aug;12(8):2181-7
references.pmid: 22548965
references.citation: Transplantation. 1991 Apr;51(4):797-800
references.pmid: 2014532
references.citation: Clin Investig. 1992 Jun;70(6):478-86
references.pmid: 1392415
references.citation: Surg Today. 2015 Mar;45(3):271-83
references.pmid: 24473669
references.citation: Circulation. 2014 Jun 24;129(25 Suppl 2):S102-38
references.pmid: 24222017
references.citation: Liver Transpl. 2014 Oct;20(10):1266-74
references.pmid: 25044355
references.citation: Transpl Int. 2005 Apr;18(4):461-6
references.pmid: 15773968
references.citation: Am J Gastroenterol. 2012 Jul;107(7):1043-50
references.pmid: 22710579
references.citation: Nutr Hosp. 2013 May-Jun;28(3):914-9
references.pmid: 23848119
references.citation: Nutr Clin Pract. 2014 Apr;29(2):222-8
references.pmid: 24526701
references.citation: Clin Liver Dis. 2005 Feb;9(1):67-81
references.pmid: 15763230
references.citation: J Gastroenterol Hepatol. 2014 Jun;29(6):1250-7
references.pmid: 24443785
references.citation: Hepatology. 1997 Jan;25(1):178-83
references.pmid: 8985287
references.citation: Am J Clin Nutr. 1999 Jun;69(6):1194-201
references.pmid: 10357739
references.citation: World J Gastroenterol. 2014 Aug 21;20(31):10682-90
references.pmid: 25152572
references.citation: Liver Int. 2014 Aug;34(7):1094-101
references.pmid: 24517561
references.citation: Pediatrics. 1972 Jul;50(1):73-83
references.pmid: 5038112
references.citation: Clin Nutr. 1997 Apr;16(2):43-55
references.pmid: 16844569
references.citation: Nutr Hosp. 2011 Nov;26 Suppl 2:27-31
references.pmid: 22411515
references.citation: Liver Transpl. 2006 Sep;12(9):1310-6
references.pmid: 16933224
references.citation: Transplantation. 2013 Sep;96(6):579-85
references.pmid: 23851933
references.citation: J Gastroenterol Hepatol. 2012 Mar;27(3):430-41
references.pmid: 22004479
references.citation: World J Gastroenterol. 2014 Jul 28;20(28):9427-38
references.pmid: 25071337
references.citation: Transplantation. 2000 Apr 15;69(7):1364-9
references.pmid: 10798755
references.citation: Am J Transplant. 2013 Mar;13 Suppl 4:304-10
references.pmid: 23465022
references.citation: Mayo Clin Proc. 1989 Jan;64(1):95-102
references.pmid: 2492064
references.citation: Hepatology. 1997 Jul;26(1):40-8
references.pmid: 9214450
references.citation: Hepatol Res. 2014 Mar;44(3):313-8
references.pmid: 23607375
references.citation: Am J Gastroenterol. 2007 Feb;102(2):412-29; quiz 468
references.pmid: 17311654
references.citation: Cochrane Database Syst Rev. 2011;(11):CD008716
references.pmid: 22071855
references.citation: Curr Gastroenterol Rep. 2001 Aug;3(4):362-70
references.pmid: 11470007
references.citation: Clin Transplant. 2011 Mar-Apr;25(2):248-54
references.pmid: 20236138
references.citation: JPEN J Parenter Enteral Nutr. 2013 Jan;37(1):68-74
references.pmid: 22421017
references.citation: Transpl Int. 2009 May;22(5):519-30
references.pmid: 19040489
references.citation: Liver Transpl. 2014 Apr;20(4):401-7
references.pmid: 24357065
references.citation: JAMA. 2014 Jul 16;312(3):294-5
references.pmid: 25027148
references.citation: J Hepatol. 1995 Aug;23(2):234-5
references.pmid: 7499801
references.citation: Dig Dis Sci. 2010 Sep;55(9):2624-8
references.pmid: 19960254
references.citation: Gastroenterol Clin North Am. 1994 Dec;23(4):673-705
references.pmid: 7698827
references.citation: Clin Transplant. 2015 Mar;29(3):216-21
references.pmid: 25557648
references.citation: Am J Gastroenterol. 1990 Dec;85(12):1597-604
references.pmid: 2252024
references.citation: Nutr Clin Pract. 2015 Aug;30(4):530-6
references.pmid: 25667232
references.citation: Lancet Oncol. 2008 Jul;9(7):629-35
references.pmid: 18539529
references.citation: Clin Interv Aging. 2012;7:585-91
references.pmid: 23269864
references.citation: Biol Trace Elem Res. 2015 May;165(1):35-40
references.pmid: 25613584
references.citation: Hepatology. 2015 Jun;61(6):2018-29
references.pmid: 25613922
references.citation: Transplantation. 2011 Oct 27;92(8):947-51
references.pmid: 21869739
references.citation: Diabetes Care. 2013 Jan;36 Suppl 1:S4-10
references.pmid: 23264424
references.citation: J Nutr. 2006 Jan;136(1 Suppl):295S-8S
references.pmid: 16365102
references.citation: Nutrition. 2013 Oct;29(10):1252-8
references.pmid: 24012087
references.citation: Hepatol Res. 2012 Oct;42(10):1008-15
references.pmid: 22548675
references.citation: Nutrition. 2011 Sep;27(9):931-7
references.pmid: 21621388
references.citation: Arthritis Care Res (Hoboken). 2010 Nov;62(11):1515-26
references.pmid: 20662044
references.citation: Hepatology. 2014 Mar;59(3):1144-65
references.pmid: 24716201
references.citation: Clin Transplant. 2015 Mar;29(3):211-5
references.pmid: 25594826
references.citation: Hepatology. 1987 Sep-Oct;7(5):821-4
references.pmid: 3308664
references.citation: Clin Sci (Lond). 1985 Nov;69(5):561-70
references.pmid: 2996827
references.citation: Am J Clin Nutr. 2014 Aug;100(2):600-8
references.pmid: 24965302
references.citation: Liver Int. 2010 Feb;30(2):208-14
references.pmid: 19840246
references.citation: Liver Transpl. 2013 Nov;19(11):1172-80
references.pmid: 23960026
references.citation: Med J Aust. 2006 Nov 20;185(10):542-3
references.pmid: 17115965
references.citation: Circulation. 2005 Oct 25;112(17):2735-52
references.pmid: 16157765
references.citation: Ann Transplant. 2009 Jul-Sep;14(3):45-50
references.pmid: 19644159
references.citation: Nat Clin Pract Gastroenterol Hepatol. 2006 Apr;3(4):202-9
references.pmid: 16582962
references.citation: Am J Gastroenterol. 1993 May;88(5):718-22
references.pmid: 8480737
references.citation: J Nutr. 2013 Aug;143(8):1263-8
references.pmid: 23739310
references.citation: Nutr Hosp. 2012 Jul-Aug;27(4):1351-6
references.pmid: 23165585
references.citation: Cochrane Database Syst Rev. 2012;5:CD008344
references.pmid: 22592729
references.citation: JAMA. 2014 Feb 5;311(5):507-20
references.pmid: 24352797
references.citation: Liver Int. 2015 Sep;35(9):2072-8
references.pmid: 25645300
references.citation: J Hepatol. 2004 Jul;41(1):38-43
references.pmid: 15246205
references.citation: Hepatology. 1993 Apr;17(4):564-76
references.pmid: 8477961
references.citation: Clin Nutr. 2006 Apr;25(2):224-44
references.pmid: 16698152
references.citation: Hepatology. 2013 Jul;58(1):325-36
references.pmid: 23471642
references.citation: Aliment Pharmacol Ther. 2013 Apr;37(7):672-9
references.pmid: 23421379
references.citation: J Gastrointest Surg. 2015 Feb;19(2):272-81
references.pmid: 25389056
references.citation: Zhonghua Gan Zang Bing Za Zhi. 2014 Jan;22(1):43-7
references.pmid: 24721243
references.citation: Clin Nutr. 2014 Oct;33(5):754-60
references.pmid: 24238850
references.citation: Transplant Proc. 2014 Jul-Aug;46(6):1807-8
references.pmid: 25131042
references.citation: Liver Transpl. 2014 Nov;20(11):1423
references.pmid: 25164498
references.citation: J Food Sci. 2008 Jun;73(5):H80-5
references.pmid: 18576999
references.citation: Gastroenterology. 1996 Dec;111(6):1679-82
references.pmid: 8942750
references.citation: Clin Nutr. 2014 Dec;33(6):958-65
references.pmid: 24656171
references.citation: Nutrition. 1993 Jul-Aug;9(4):339-43
references.pmid: 8400590