Changes in nutritional status after liver transplantation

Abstract

Chronic liver disease has an important effect on nutritional status, and malnourishment is almost universally present in patients with end-stage liver disease who undergo liver transplantation. During recent decades, a trend has been reported that shows an increase in number of patients with end-stage liver disease and obesity in developed countries. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognised. Cirrhotic patients with depleted lean body mass (sarcopenia) and fat deposits have an increased surgical risk; malnutrition may further impact morbidity, mortality and costs in the post-transplantation setting. After transplantation and liver function is restored, many metabolic alterations are corrected, dietary intake is progressively normalised, and lifestyle changes may improve physical activity. Few studies have examined the modifications in body composition that occur in liver recipients. During the first 12 mo, the fat mass progressively increases in those patients who had previously depleted body mass, and the muscle mass recovery is subtle and non-significant by the end of the first year. In some patients, unregulated weight gain may lead to obesity and may promote metabolic disorders in the long term. Careful monitoring of nutritional changes will help identify the patients who are at risk for malnutrition or over-weight after liver transplantation. Physical and nutritional interventions must be investigated to evaluate their potential beneficial effect on body composition and muscle function after liver transplantation.

Keywords: Liver transplantation, Sarcopenia, Malnutrition, Obesity, Metabolic syndrome, Outcome, Survival

Core tip: Malnutrition, evidenced by muscle and fat depletion, represents a negative prognostic factor for morbidity and mortality in cirrhotic patients. This factor applies when liver transplantation is indicated. Nutritional depletion, as shown in the general population undergoing major surgery, may influence the outcome and global resource utilisation of liver transplantation. Recently, attention has focused on changes in nutritional status after liver transplantation. While fat mass is easily regained, muscle wasting, when present, is difficult to revert during the first year. The benefits derived from interventional programmes, such as exercise and dietary counselling, must be carefully evaluated in these types of patients.