Heart transplant nutrition programs: a national survey

Cardiac cachexia and nutritional inadequacies have been cited as risk factors for poor outcome after heart transplantation. To evaluate the current status of nutritional support programs for heart transplant patients, we conducted a national survey of major transplant centers. Surveys were sent to 26 institutions, with 20 hospitals responding to the written questionnaire and providing samples of educational material from their nutrition programs. Although 80% of the hospitals surveyed included a dietitian as a member of the nutritional support team, dietitians participated in only 50% of the pretransplant teaching conferences. Nutritional status and care plans were discussed with patients and family members during the pretransplant conferences. At most centers (88%) nutritional status was assessed on a routine basis before the procedure. After transplantation, nutritional assessments were usually performed every 7 to 10 days. During the 2 to 4 weeks after surgery, the most common diets prescribed were low-fat, low-cholesterol diets that typically limited sodium intake. Thirty percent of the hospitals also restricted patients from eating fresh fruits and vegetables for 3 to 4 weeks after surgery, theoretically to minimize risk of certain infections. After patient discharge, most centers (68%) monitored nutritional status of patients during periodic clinic visits and yearly evaluations. This study demonstrated that nutritional management has become an important factor in the total medical care of the heart transplant patient. Findings of this survey were used to develop nutritional support program guidelines for heart transplant recipients at our institution. Further research is necessary before a standardized procedure for assessing and monitoring nutritional status of heart transplant patients can be developed.