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[Liver transplantation in pediatrics. Nutritional measures]
I Recuenco1, M Ruano, R Gutiérrez
1Servicio de Farmacia, Hospital La Paz, Madrid, España.
Insights
Malnutrition is common in liver transplant candidates. Immediate post-transplant nutrition support, specifically total parenteral nutrition (TPN), may reduce infection risk and ICU stay in pediatric liver transplant recipients.
Area of Science:
- Pediatric Intensive Care
- Transplant Surgery
- Nutritional Support
Background:
- Malnutrition is prevalent in liver transplant candidates.
- Pre-operative nutritional interventions are challenging.
- Post-transplant nutritional support is crucial for pediatric liver transplant recipients.
Purpose of the Study:
- To evaluate the impact of immediate post-transplant total parenteral nutrition (TPN) on pediatric liver transplant outcomes.
- To compare infection rates, intensive care unit (ICU) length of stay, and survival rates between children receiving TPN and those receiving enteral nutrition.
Main Methods:
- Retrospective study of pediatric liver transplant recipients from 1992.
- Two groups: Group A (immediate TPN) and Group B (enteral nutrition).
- Analysis of clinical records, focusing on nutritional interventions, complications, ICU stay, and survival.
Main Results:
- Group A (TPN) showed a 3.2 relative risk of infection compared to Group B.
- Group A patients had a significantly longer ICU stay (13.4 days) than Group B (6.28 days).
- Survival rates were 86.6% for TPN group and 71.4% for enteral nutrition group (not significant).
Conclusions:
- Immediate post-transplant TPN in pediatric liver transplant recipients was associated with increased infection risk and longer ICU stays.
- While survival rates were high in the TPN group, the study could not definitively link TPN to improved outcomes due to variability in patient conditions.
Abstract:
Malnutrition is a constant in candidates for liver transplant. Because of their particular characteristics, pre-operative nutritional intervention is difficult to apply, so that post-transplant action is necessary. A retrospective study was made, reviewing the clinical records of all the children undergoing liver transplants in 1992 in the "La Paz" Children's Hospital, while they were in the Pediatric Intensive Care Unit. Two groups of patients were established--A and B--respectively of 15 and 7 children, according to whether or not they had received immediate post-transplant TPN. In Group A, a total of 150 days was evaluated, with TPN (x = 10 +/- 8.3). The amino acid solutions used were for liver insufficiency (48.8%), Kidney insufficiency (33.3%) and standard (17.8%). Lipids were administered on 6.3% of days in four patients' nutrition. In 54.5% of interventions, infectious complications occurred due to immune-suppression. Comparison of the two patient groups show significant results: those in Group A had a 3.2 relative risk of suffering infection (certainty interval 1.3-1.8). In terms of time in the ICU, the Group A patients were admitted for an average of 13.4 days (range 2-37) as opposed to the 6.28 days of Group B (range 3-15). Results were significant, with p < 0.05. In terms of evolution, the survival rate in patients receiving TPN was 86.6% against 71.4% in those receiving enteral nutritional (n.s.). Our results show a high rate of survival (86.6%). It is not possible to conclude the extent to which the introduction of TPN influenced post-operative evolution, as there was no consistency in terms of the patients' clinical situation.