Yadav Sanjay Kumar, Choudhary Narendra Singh, Saraf Neeraj, Saigal Sanjiv, Goja Sanjay, Rastogi Amit, Bhangui Prashant, Soin A S
Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, 122 001, India.
Indian J Gastroenterol. 2017 Jul;36(4):275-281. doi: 10.1007/s12664-017-0779-8. Epub 2017 Aug 31.
Malnutrition is an important risk factor for adverse outcomes in patients awaiting liver transplant. Living donor liver transplant, being an elective procedure, allows nutritional rehabilitation and optimization of these patients before transplant.
This paper aimed to evaluate the outcome of end-stage liver disease (ESLD) patients with various degrees of malnutrition waiting for living donor liver transplant.
Nutritional status was assessed using subjective global assessment (SGA) in patients who were evaluated for a liver transplant at our center from January 2015 to September 2015. All the data were collected prospectively. Predictive factors for mortality were analyzed using logistic regression and survival was obtained using Kaplan-Meier curves.
One hundred and seventeen patients were grouped based on their nutrition status into normal, mild-moderate, and severe malnutrition. The groups were comparable in terms of age, sex, etiology of liver disease except alcoholic liver disease. Graft recipient weight ratio was comparable among groups. There was no significant difference in hospital stay. However, severe malnourished patients had higher incidence of sepsis (p=0.005) and death due to sepsis (p=0.01). Nutritional status was the only independent predictor of mortality on multivariate analysis.
Nutritional status measured with SGA independently predicts short-term outcome of ESLD patients waiting and after living donor liver transplant.
营养不良是等待肝移植患者出现不良结局的重要风险因素。活体肝移植作为一种择期手术，能够让这些患者在移植前进行营养康复和优化。
本文旨在评估不同程度营养不良的终末期肝病（ESLD）患者等待活体肝移植的结局。
对2015年1月至2015年9月在本中心接受肝移植评估的患者，采用主观全面评定法（SGA）评估营养状况。所有数据均前瞻性收集。使用逻辑回归分析死亡预测因素，并通过Kaplan-Meier曲线获得生存率。
117例患者根据营养状况分为正常、轻中度和重度营养不良组。除酒精性肝病外，各组在年龄、性别、肝病病因方面具有可比性。各组的移植物受者体重比相当。住院时间无显著差异。然而，重度营养不良患者的败血症发生率较高（p = 0.005），败血症导致的死亡率较高（p = 0.01）。多因素分析显示，营养状况是唯一独立的死亡预测因素。
用SGA评估的营养状况可独立预测ESLD患者等待及活体肝移植后的短期结局。
