Screen Liver Transplant Candidates For Malnutrition
Malnutrition is common among patients with cirrhosis awaiting liver transplants and can negatively impact patients’ survival, quality of life, and their ability to respond to stressors, such as infections, before and after surgery, according to a recent review.1
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In the review, the researchers emphasized the importance of assessing patients with cirrhosis for sarcopenia, a feature of protein malnutrition associated with increased morbidity and mortality. “Muscle wasting is one of the major features of undernutrition in cirrhosis, and currently, high resolution image-based techniques such as computed tomography constitute the best way to evaluate body composition in these patients,” said senior author Dr Aldo J Montano-Loza, at the University of Alberta, Canada.2 However, this condition is often overlooked due to the lack of standards for nutritional assessment and challenges in taking objective measurements, such as fluid retention and obesity.
Additionally, the researchers recommended that physicians make sure patients awaiting a liver transplant are consuming the appropriate number of calories and protein and do not fast for longer than 6 hours. While the benefits of consuming branched-chain amino acids or fish oil supplements and taking hormone replacement therapy have not been confirmed in clinical trials, the researchers noted that they could supplement traditional therapies used to treat patients with malnutrition.
Physical activity was also recommended as an important part of malnutrition therapy. “Supervised mobilization should be encouraged and physiotherapy should be consulted liberally when patients are in the hospital to minimize total bed rest and muscle atrophy,” said Dr Montano-Loza.”2
Furthermore, the authors highlighted the importance of clinicians to be aware of guidelines for diet and exercise, especially for cirrhosis patients who do not have access to dieticians and exercise specialists.
—Melissa Weiss
Reference:
1. Mazurak VC, Tandon P, Montano-Loza AJ. Nutrition and the transplant candidate [published online October 26, 2017]. Liver Transpl. doi:10.1002/lt.24848.
2. The importance of addressing poor nutrition in patients with liver failure [press release]. Wiley; October 26, 2017. http://newsroom.wiley.com/press-release/liver-transplantation/importance-addressing-poor-nutrition-patients-liver-failure. Accessed October 26, 2017.