Kelly D A
The Liver Unit, The Birmingham Children's Hospital NHS Trust, United Kingdom.
Pediatr Transplant. 1997 Aug;1(1):80-4.
Malnutrition is present in approximately 60% of children at the time of liver transplantation. The pathogenesis of malnutrition is complex and includes reduced calorie intake, fat malabsorption, abnormal nitrogen metabolism, and increased energy expenditure leading to increased calorie requirements. As nutritional status at transplantation is a significant factor in both morbidity and mortality post liver transplantation, intensive nutritional support pre-transplant is vital and may be achieved with a modular feed providing 120-150% estimated average requirement (EAR). Approximately 80% of children who survive liver transplantation will achieve normal growth and nutritional status within 12 months post-transplant. Significant factors responsible for growth failure post-transplant include pre-operative nutritional status (height SDS score <-2), continued glucocorticoid administration, recurrent hepatic dysfunction or chronic rejection and reduced calorie intake due to behavioural feeding problems. Effective future strategies include intensive pre- and post-operative nutritional support and early reduction of glucocorticoid administration.
在肝移植时，约60%的儿童存在营养不良。营养不良的发病机制复杂，包括热量摄入减少、脂肪吸收不良、氮代谢异常以及能量消耗增加导致热量需求增加。由于移植时的营养状况是肝移植后发病率和死亡率的重要因素，移植前的强化营养支持至关重要，可通过提供估计平均需求量（EAR）的120 - 150%的组件式喂养来实现。约80%存活的肝移植儿童将在移植后12个月内实现正常生长和营养状况。移植后生长发育迟缓的重要因素包括术前营养状况（身高标准差评分<-2）、持续使用糖皮质激素、反复出现肝功能障碍或慢性排斥反应以及因喂养行为问题导致的热量摄入减少。未来有效的策略包括强化术前和术后营养支持以及早期减少糖皮质激素的使用。
