[Liver transplant. Nutritional implications]

Most of the patients who are candidate to liver transplant have varying degrees of hyponutrition. That is why they may be subsidiary to receive nutritional therapy so as to improve their nutritional status and the transplant outcomes. However, preoperative support is difficult to perform in many cases due to multiple factors among which the patients clinical situation, the diagnostic requirements, the therapeutic regimens, and extra-hospital care of the "stable" candidates may be listed. In the post-surgical phase, the patients must receive nutritional support in the same way other patients submitted to major surgery do. Early enteral nutrition is the most appropriate method in most of the cases, for which intraoperative placement of a transpyloric access to the digestive tract is recommended, usually through a naso-jejunal tube. Enteral nutrition should be maintained until nutritional requirements may appropriately be covered by oral feeding. Immunosuppressive therapy importantly contributes to the development of such problems after transplantation through its secondary metabolic-nutritional effects. The patients require nutritional follow-up not only to assess the evolution of their nutritional status but also to detect, prevent, and treat late-onset impairments such as obesity, hyperlipidemia, or osteoporosis, which commonly occur in these patients.