Lorden Heather, Engelken Jessa, Sprang Katrina, Rolfson Megan, Mandelbrot Didier, Parajuli Sandesh
Division of Transplantation, Department of Clinical Nutrition, UW Health Hospital and Clinics, Madison, Wisconsin, USA.
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Clin Transplant. 2023 Nov;37(11):e15138. doi: 10.1111/ctr.15138. Epub 2023 Sep 16.
Screening for malnutrition is of vital importance for solid organ transplant candidates to optimize nutrition status before transplant, to improve clinical outcomes and to inform selection committees of nutritional contraindications and risks. There are multiple criteria and screening tools available for determining malnutrition diagnosis and risk. Registered Dietitian Nutritionists use these tools for nutrition assessments to quantify the severity of malnutrition, provide patient-centered interventions, and monitor progression. Many transplant centers in the United States utilize the American Society of Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics' Adult Malnutrition Criteria, though there is limited research using these criteria specifically in the transplant population. Malnutrition, utilizing other diagnostic and screening tools, has been associated with important complications, including longer length of hospital stay, increased mortality, decreased quality of life, worsened end-stage organ progression, and decreased functional status. Malnutrition typically results from sarcopenia and cachexia, and can ultimately lead to frailty, causing further negative impacts on transplant outcomes. This literature review summarizes the current research on malnutrition in solid organ transplant candidates and provides recommendations for future research and current practice implications.
对实体器官移植候选人进行营养不良筛查至关重要，这有助于在移植前优化营养状况、改善临床结局，并向选拔委员会通报营养方面的禁忌证和风险。有多种标准和筛查工具可用于确定营养不良的诊断和风险。注册营养师使用这些工具进行营养评估，以量化营养不良的严重程度、提供以患者为中心的干预措施并监测进展情况。美国许多移植中心采用美国肠外肠内营养学会和营养与饮食学会的成人营养不良标准，不过专门针对移植人群使用这些标准的研究有限。利用其他诊断和筛查工具发现，营养不良与重要并发症相关，包括住院时间延长、死亡率增加、生活质量下降、终末期器官病变恶化以及功能状态降低。营养不良通常由肌肉减少症和恶病质导致，最终可能导致身体虚弱，对移植结局产生进一步负面影响。这篇文献综述总结了目前关于实体器官移植候选人营养不良的研究，并为未来研究和当前实践应用提供了建议。
