Nutrition therapy: Integral part of liver transplant care

Table 3 Nutritional recommendations in pre and peri liver transplant

Nutrients/Diet	Recommendations	Observations
Pre-transplant
Calories	35-40 kcal/kg	Avoid fasting for longer than 3-6 h during daytime; encouraged to take small, frequent meals distributed throughout the day
Protein	1.2-1.5 g/kg	It is suggested diets rich in vegetables and dairy protein
Carbohydrates	50%-70%	A late-evening snack of 50 g of complex carbohydrates is suggested to reverse aberrant substrate utilization and improve nitrogen retention
Fat	30%	It should not be restricted, unless true fat malabsorption has been diagnosed using a fecal fat test or slower gastric emptying is reported
Fiber	25-45 g/d	Prebiotics fermentation seems to have a beneficial effect on neuropsychiatric performance
Vitamin and minerais	Dietary Reference Intakes	Or pharmacological doses in case of deficiency
Peri-transplant
Calories	25-30 kcal/kg	Use indirect calorimetry if it is available
Proteins	1.5-2.0 g/kg	In the immediate phase after the operation, protein catabolism is markedly increased
Food/enteral nutrition		Early normal food or enteral nutrition (12 h) after liver transplant is advisable as long as the patient is hemodynamically stable and has no nausea or vomiting