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Child-Pugh class, nutritional indicators and early liver transplant outcomes
W J Abbott1, A Thomson, C Steadman
1Nutrition Services, Princess Alexandra Hospital, Brisbane, Australia 4102.
Insights
Child-Pugh class C in liver transplant patients correlates with increased early postoperative complications. Nutritional status, while linked to disease type, did not predict one-year survival in this study.
Area of Science:
- Hepatology
- Transplantation Surgery
- Clinical Nutrition
Background:
- Patients with chronic liver disease often experience reduced body fat and muscle mass.
- The predictive value of nutritional indicators and Child-Pugh class on transplant outcomes remains unclear.
Purpose of the Study:
- To assess the impact of preoperative Child-Pugh class and nutritional status on early transplant outcomes and one-year survival.
- To explore the relationship between nutritional indicators, Child-Pugh class, and liver disease type.
Main Methods:
- Nutritional indicators included grip strength, triceps skinfold thickness, and mid-arm muscle area.
- Outcomes measured were ventilator time, intensive care unit (ICU) stay, hospital stay, and one-year survival.
- Study included 80 adult liver transplant patients (1990-1994).
Main Results:
- Child-Pugh class C patients experienced longer ventilation and ICU stays compared to classes A and B.
- No significant association was found between hospital stay duration and Child-Pugh class.
- Grip strength and mid-arm muscle area were lower in Child-Pugh classes B and C; parenchymal liver disease correlated with lower grip strength and muscle area.
Conclusions:
- Child-Pugh class C is linked to increased early postoperative morbidity.
- Advanced Child-Pugh class correlates with diminished muscle status and is associated with parenchymal liver disease.
Background/Aims:
Patients with chronic liver disease undergoing liver transplantation have reduced body fat and muscle mass. The extent to which nutritional indicators and Child-Pugh class are predictive of postoperative outcome in adults is unclear. The aims of this study were to determine in adult patients undergoing transplant 1) the influence of preoperative Child-Pugh class and nutritional indicators on early transplant outcomes and one-year survival, 2) the relationship between nutritional indicators and Child-Pugh class and disease type. This study included 80 patients (1990-1994).
Methodology:
The nutritional indicators utilized were grip strength, triceps skinfold thickness and uncorrected mid-arm muscle area. Measured outcomes were ventilator time, intensive care stay, postoperative hospital stay and one-year survival.
Results:
Early morbidity was determined in survivors. Child-Pugh class C patients required longer ventilation and spent more time in the intensive care unit than Child-Pugh classes A and B. No significant relationships were found for length of hospital stay. Relationships between the nutritional indicators (when controlled for Child-Pugh class) and early morbidity could not be determined due to insufficient data. No relationship was established between one-year survival and Child-Pugh class or the nutritional indicators. Grip strength and mid-arm muscle area were lower in the patients in Child-Pugh classes B and C. Parenchymal liver disease was associated with lower grip strength and mid-arm muscle area when compared to cholestatic disease.
Conclusions:
Child-Pugh class C is associated with greater early postoperative morbidity. Advanced Child-Pugh class is also associated with diminished muscle status and parenchymal disease.
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