MALNUTRITION IN LIVER TRANSPLANT PATIENTS

医学 肝移植 四分位间距 外科 肝病 暴发性肝衰竭 移植 并发症 低温沉淀 营养不良 前瞻性队列研究 胃肠病学 内科学 纤维蛋白原
作者
Gerald R. Stephenson,Eugene W. Moretti,Habib El-Moalem,Pierre A. Clavien,Janet E. Tuttle‐Newhall
出处
期刊:Transplantation [Wolters Kluwer]
卷期号:72 (4): 666-670 被引量:191
标识
DOI:10.1097/00007890-200108270-00018
摘要

Malnutrition is a common complication of end-stage liver disease. It is frequently not a priority of treatment before liver transplantation. The purpose of this study was to examine whether prospective preoperative nutritional assessment could predict resource utilization and outcome after liver transplantation.We retrospectively reviewed 109 sequential orthotopic liver transplants performed at our center between July 1996 and May 1999. Ten patients with fulminant hepatic failure were excluded from the study, leaving 99 patients. Nutritional status was determined at the time of transplantation using subjective global assessment. Wilcoxon rank sum test and rank analysis of variance were used to analyze the data. Results are reported as median (interquartile range). A P value <0.05 was considered significant.Intraoperative transfusion requirements of packed red blood cells and cryoprecipitate was higher in the patients with severe malnutrition in comparison to the mild and moderate groups (severe vs. moderate, 5.5+/-5.5 vs. 3.0+/-6, P=0.026; vs. mild, 1.5+/-3, P<0.0001). The severe group required more fresh-frozen plasma intraoperatively than the mild group (mild vs. severe, 0+/-2 vs. 2+/-6, P=0.0007; vs. moderate, 1+/-4, P=0.071). Patients in the severe group had longer postoperative lengths of stay compared with patients in the moderate and mild groups (severe vs. moderate, 16+/-9 days vs. 10+/-5 days, P=0.0027; vs. mild, 9+/-8 days, P=0.0006).Subjective global assessment is an excellent independent predictor of outcome in patients undergoing liver transplantation. Severely malnourished patients require more blood products during surgery and have prolonged postoperative length of stay in hospital. Our data suggest that if nutritional repletion is possible in patients with end-stage liver disease before transplantation, patient outcomes could be improved.
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