Assessment of nutritional status and methods for its correction in patients on the waiting list for liver transplantation

Objective: to develop rational modes of nutritional status correction in patients with diffuse liver diseases on the liver transplantation (LT) waiting list (WL).

Subjects and methods. A comprehensive examination was made in 82 patients with hepatic cirrhosis who were included into the LT WL and allocated to 3 groups. The patients were matched for age, gender, and the severity of their condition. Nutritional status parameters and energy expenditures were studied in all the groups. Complex methods to calculate nutritional status parameters, energy expenditures, and nutrient needs were used to evaluate malnutrition.

Results and discussion. Assessment of nutritional status, metabolism, and nutritional therapy revealed disorders in 64 (78%) patients on the LT WL. Normal nutritional status was found in 18 (22%) patients; mild, moderate, and severe protein-energy malnutrition was detectable in 18 (22%), 40 (48.8%), and 6 (7.3%) patients, respectively. The patients with moderate and severe malnutrition were given oral balanced feeding formulas in addition to diet therapy. To correct imbalance of blood amino acid composition, 10 patients were given hepamin in combination therapy for hepatic encephalopathy. During the performed therapy, there was a significant reduction in serum ammonia levels and improved psychometric testing results.

Conclusion and practical guidelines. When HC patients are referred to the LT WL and admitted to hospital for surgery, it is necessary to make an integrated assessment of nutritional status and to define the degree of malnutrition. An individual nutritional support plan must be complied for patients with moderate and severe malnutrition and for those with postoperative complications.

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