Abstract
Rationale: Malnutrition (M) is a multifactorial process in children with chronic liver disease and carries an increased risk of morbidity and mortality. Maintaining optimal NS can prevent further derangement of liver function: increasing metabolic energy and improving the immunology status. In fact, M adversely affects on the outcome of surgical patients (pts). In this study we intend to demonstrate how the NS can influence the outcome of liver transplant (LTx) in the paediatric population. Methods: We evaluated 74 paediatric pts over 24 months from 2006 to 2007 who underwent LTx at ISMETT. The age of the pts ranged between 18 months and 12 years. The causes of the LTX were: 43%biliary atresia, 10%hepatoblastoma, 10%acute fulminant hepatitis, 7%graft non function, 5%autoimmune hepatitis and 25%other. Upon admission, the pts undergo a nutritional screening by a multidisciplinary team (physicians, clinical pharmacists, dietitians) who assess the NS and establish a customized nutritional plan based on the clinical needs. The nutritional assessment includes: clinical history, a retrospective analysis of the NS, anthropometrical (National Center of Health Statistics Tables) and biochemistry data. Results: Of the 74 pts assessed immediately before the LTx, 14 were between 3o-5opercentile weight/height (wt/ht): severe M, 20 were between 10o-25o: moderate M, 30 between 25o-50o: normal NS and only 5 pts were above 50o: good NS. Of the 14 pts between 3o-5opercentile wt/ht, there were 2 deaths and 7 pts underwent redo-LTx and the average length of stay (LOS) was 50 days. Of the 20 pts between 10o-25opercentile wt/ht only 2 underwent redo-LTx and 12 had post-surgery complications, the average LOS was 30 days. Of the 35 pts between 25o50opercentile wt/ht there was 1 death and 7 pts had complications post-surgery while the average LOS was around 30 days. Conclusion: As the results show, the NS can effectively be a prognostic indicator in the LTx, as optimal nutrition may prevent further derangement of liver function.
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