The Continuity of Nutrition Care Through Liver Transplantation

Abstract

AbstractRecent advancements in pharmacotherapies and medical technologies have significantly improved long‐term survival rates after liver transplantation. However, as survival rates increase, so do incidences of other chronic diseases more commonly associated with advanced age. In fact, as a population, post‐liver‐transplant patients are at greater risk for cardiovascular disease, diabetes mellitus, cancer, and osteoporosis than the general public. Moreover, disease risk factors such as hyperglycemia, dyslipidemia, hypertension, and excess weight gain continue to plague this population despite reduced‐dose requirements for immunosuppressives—a class of drugs with numerous side effects—which, historically, were thought to contribute heavily to chronic disease risk. Thus, clinicians treating liver‐transplant candidates are challenged to broaden the scope of their care to include prevention of other chronic diseases that may have strong nutritional components. Although nutrition and medical therapies should continue to treat specific symptoms associated with the stages of liver disease and transplantation, therapies and information provided to pre‐transplant patients should include preventative measures to ensure optimal outcomes for improved longevity after transplant. The medical team should utilize the nutritional expertise of dietitians to lead this continuity of care through all stages of liver transplantation. To maximize longevity and quality of life, dietary intervention for chronic disease prevention should be implemented as soon as medically feasible. This paper reviews nutrition therapies for complications seen during liver transplantation and proposes individualized diet recommendations to be considered at the very earliest stages of caring for patients with liver disease.