Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, Texas, USA.
Multivisceral Transplant Unit/Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, Padova, Italy.
Clin Transplant. 2022 Oct;36(10):e14647. doi: 10.1111/ctr.14647.
Malnutrition is a known risk factor for postoperative morbidity and mortality in patients awaiting liver transplantation (LT). Malnutrition is a potentially reversible risk factor, though there are no clear guidelines on the best mechanism for an improvement. It also remains unclear if preoperative nutritional interventions have benefits to post-transplant outcomes for transplant recipients.
Primary objective: To identify if preoperative optimization of nutritional status is associated with improved short-term outcomes after LT.
To determine if preoperative improvement of malnutrition improves short-term outcomes after LT, as well as if weight loss in obese patients affects short-term outcomes after LT.
Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.
Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. POSPERO Protocol ID: CRD42021237450 RESULTS: 3851 records were identified in searching the databases, 3843 records were excluded by not fulfilling eligibility criteria. Seven full-text articles were included for the final analysis of which three were randomized controlled trials, one was prospective observational studies, and three were retrospective observational studies. No appreciable difference in mortality, post-transplant complication rate was noted across the studies. Length of stay (LOS) was noted to be shorter in two observational studies of Vitamin D deficiency in liver transplant patients.
We have made a weak recommendation supporting pre-transplant nutritional supplementation due to possible benefit in reducing LOS as well as the lack of harm (Quality of Evidence low | Grade of Recommendation; Weak). No effective conclusions were reached for the secondary objectives due to the conflicting evidence.
营养不良是肝移植（LT）患者术后发病率和死亡率的已知危险因素。尽管对于改善营养不良的最佳机制尚无明确的指南，但营养不良是一个潜在可逆转的危险因素。对于接受移植的患者，术前营养干预是否对移植后的结果有益，目前仍不清楚。
主要目标：确定 LT 术后营养状况的术前优化是否与短期结果改善相关。
确定 LT 术前改善营养不良是否改善 LT 后的短期结果，以及肥胖患者的体重减轻是否影响 LT 后的短期结果。
Ovid MEDLINE、Embase、Scopus、Google Scholar 和 Cochrane Central。
根据国际专家小组提出的 GRADE 方法，遵循 PRISMA 指南和建议进行系统评价。POSPERO 方案 ID：CRD42021237450
在数据库中搜索共确定了 3851 条记录，通过不满足入选标准排除了 3843 条记录。最终分析纳入了 7 篇全文文章，其中 3 篇为随机对照试验，1 篇为前瞻性观察性研究，3 篇为回顾性观察性研究。在这些研究中，没有观察到死亡率或移植后并发症发生率的明显差异。在两项关于肝移植患者维生素 D 缺乏的观察性研究中，观察到住院时间（LOS）缩短。
由于术前营养补充可能有助于缩短 LOS，且没有危害（证据质量低|推荐等级；弱），因此我们提出了一个弱推荐，支持在移植前进行营养补充。由于证据相互矛盾，对于次要目标，我们没有得出有效的结论。
