Impact of malnutrition and its therapy on liver transplantation.

The consequences of malnutrition and impact of nutritional support on the liver transplant patient have not been adequately addressed in clinical research studies. As we have gained experience in assessing patients for transplantation surgery, the risks of malnutrition have been realized. Part of the success of liver transplantation today is related to improved timing of surgery, patient selection, and perioperative management. Malnutrition is one of the adverse risk factors that is potentially reversible and therefore specialized nutritional support techniques should be able to improve postsurgical outcome. However, the performance and interpretation of nutritional research has been impeded by difficulties in separating the effects of liver dysfunction from disturbances secondary to nutritional deficiencies; for example, hypoproteinemia would be a consequence of both. Through the use of multivariate prognostic formulas and development of better nutritional indices for patients with liver disease, it should be possible to identify those patients who will receive the greatest benefit from preoperative and perioperative nutritional support. Furthermore, the kinds of nutritional supplementation having the greatest impact could then be determined.