Impact of pretransplant nutritional status in patients undergoing liver transplantation

Protein-energy malnutrition is common in patients with end-stage liver disease requiring liver transplantation and is a risk factor for posttransplant morbidity including sepsis. We therefore investigated the relationship between preoperative nutritional status and postoperative clinical course, and the risk factors for postoperative sepsis in patients undergoing living donor liver transplantation (LDLT), focusing on nutritional parameters.

We preoperatively measured body cell mass (BCM) using a body composition analyzer and various nutritional parameters including prealbumin, branched-chain amino acids (BCAA)/tyrosine ratio, and zinc in 50 consecutive recipients undergoing LDLT between February 2008 and February 2009. Risk factors for post-transplant sepsis were analyzed.

The incidence of postoperative severe infection and in-hospital death was significantly higher in patients with preoperative low BCM than in patients with normal or high BCM. Multivariate predictors of posttransplant sepsis included preoperative low BCM (p = 0.016), absence of preoperative supplementation with BCAA-enriched nutrient mixture (p = 0.028), and a Model for End-stage Liver Disease score of 20 or above (p = 0.040).

Preoperative BCM level was closely related to the postoperative clinical course in patients undergoing LDLT. Pretransplant nutritional status and supplementation with BCAA-enriched nutrient mixture have potent impacts on the incidence of postoperative sepsis.