Impact of pretransplant malnutrition on short-term clinical outcomes of liver transplantation - An exploratory study

Abstract

Introduction: Malnutrition is highly prevalent among patients undergoing liver transplantation (LT) and can affect various clinical factors. The present study focuses on the impact of pretransplant malnutrition on various short-term outcomes of LT. Methods: Ninety LT recipients undergoing elective living donor LT were recruited in the study. Based on subjective global assessment (SGA), they were grouped as normal, moderate, and severely malnourished. Information regarding prognostic factors (Child-Turcotte-Pugh [CTP] and Model for End-Stage Liver Disease [MELD] scores), biochemical parameters (hemoglobin, TLC, platelets, bilirubin [T], serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, albumin, creatinine, and sodium), dietary intake, % weight loss, and short-term outcomes (hospital stay, intensive care unit days, blood unit usage during surgery, and dead and alive status after 1 year) were gathered. Results: The recipient evaluation showed that 54.4% of the patients were moderately malnourished and 27.8% of the patients were severely malnourished. The prognostic scores, CTP, and MELD significantly had higher scores in moderately and severely malnourished patients (P < 0.001 and P = 0.003). Among the biochemical parameters, hemoglobin, albumin, and sodium showed significantly lower levels in moderately and severely malnourished patients (P < 0.001, P = 0.02, and P = 0.01). The data also showed a significantly higher degree of ascites, % weight loss, and lower calorie intake among malnourished patients. A higher degree of malnutrition was associated with poor outcomes of LT; higher hospital stay (P = 0.014), packed red blood cell unit usage during surgery (P = 0.005), and deaths after 1 year of LT (P = 0.03). Conclusion: Pre-LT malnutrition by SGA was associated with poor short-term outcomes of LT with higher hospital stay and deaths. Hence, the present data emphasize the need for early nutrition intervention for improved surgery results.