Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan.
Department of General Surgery, Mansoura University, Mansoura 35516, Egypt.
Nutrients. 2017 Oct 16;9(10):1126. doi: 10.3390/nu9101126.
Protein-energy malnourishment is commonly encountered in patients with end-stage liver disease who undergo liver transplantation. Malnutrition may further increase morbidity, mortality and costs in the post-transplantation setting. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognized. The metabolic abnormalities induced by liver failure render the conventional assessment of nutritional status to be challenging. Preoperative loss of skeletal muscle mass, namely, sarcopenia, has a significant detrimental impact on post-transplant outcomes. It is essential to provide sufficient nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the needed energy intake. Herein, the latest currently employed perioperative nutritional interventions in liver transplant recipients are thoroughly illustrated including synbiotics, micronutrients, branched-chain amino acid supplementation, immunonutrition formulas, fluid and electrolyte balance, the offering of nocturnal meals, dietary counselling, exercise and rehabilitation.
蛋白质能量营养不良在接受肝移植的终末期肝病患者中很常见。营养不良可能会进一步增加移植后的发病率、死亡率和成本。在对肝移植候选患者进行评估时，仔细评估营养状况的重要性已得到广泛认可。肝功能衰竭引起的代谢异常使得常规的营养状况评估变得具有挑战性。术前骨骼肌量的丢失，即肌少症，对移植后的结果有显著的不利影响。在肝移植的所有阶段都必须提供充足的营养支持。首选口服营养，但可能需要管饲肠内营养来提供所需的能量摄入。本文详细阐述了目前在肝移植受者中应用的围手术期营养干预措施，包括合生元、微量营养素、支链氨基酸补充、免疫营养配方、液体和电解质平衡、提供夜间餐、饮食咨询、运动和康复。
