Korean J Transplant.  2020 Mar;34(1):38-46. 10.4285/kjt.2020.34.1.38.

Poor preoperative enteral nutrition would be a risk factor for readmission due to infection after liver transplantation

• Seo KW
• Seo KI
• Ha HM
• Lee JY
• Choi YI
• Moon HH
• Kim KH
• Shin YM
• Park YS
• Cho HR

• KMID: 2503781
• DOI: http://doi.org/10.4285/kjt.2020.34.1.38

Abstract

Background
Most patients who undergo liver transplantation (LT) have advanced cirrhosis and poor nutritional status. The aim of this study was to investigate the effect of enteral nutrition (EN) on the clinical outcomes after LT.
Methods
From 2015 to 2019, the medical records of recipient of LT at Kosin University Gospel Hospital were retrospectively reviewed.
Results
Thirty-seven patients underwent LT. Nineteen patients underwent living donor liver transplantation (LDLT) and 18 patients underwent deceased donor liver transplantation (DDLT). One LDLT patient was excluded because transplantation was done within 1 month. Five DDLT patients were excluded either because they died within 1 month (n=4) or received transplantation within 1 month. (n=1). Therefore, 31 patients were analyzed. Psoas-muscle index (P=0.715) and serum albumin (P=0.111) were not statistically different between the LDLT and DDLT groups. Four patients (4/31) were readmitted because of infection. One LDLT patient was diagnosed with genitourinary infection. The three DDLT patients were diagnosed with pulmonary tuberculosis (n=1), diverticulitis (n=1), and sepsis (n=1). Readmission caused by infection was not statistically different between LDLD and DDLT patients (P=0.284). Preoperative EN <25% of the recommended amount (P=0.016) was significantly associated with readmission related to infection. In multivariate analyses, preoperative EN <25% was an independent risk factor for readmission due to infection after LT regardless of psoas-muscle index, baseline Model for End-Stage Liver Disease score, or LT type.
Conclusions
Preoperative poor EN is significantly associated with readmission risk due to infection within 3 months of LT.

Keyword

Liver transplantation; Enteral nutrition; Infection; Psoas-muscle index

Figure

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  Fig. 1 Flowchart of study population. A total of 37 patients underwent liver transplantation (LT): 18 with deceased donor liver transplantation (DDLT) and 19 with living donor liver transplantation (LDLT). Recipients survived for more than 3 months after LT were enrolled in this study. In the DDLT group, four patients died within 1 month after LT and 1 patient received transplantation within 1 month. One patient in the LDLT group received transplantation within 1 month. One patient with LDLT was diagnosed with genitourinary infection and hospitalized. Three patients who received DDLT were diagnosed and hospitalized for pulmonary tuberculosis, diverticulitis, and sepsis, respectively.

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  Fig. 2 Pre-LT enteral nutrition and readmission due to infection after liver transplantation (LT). Six patients were ingesting <25% of the recommended enteral nutrition supply before transplantation, and three (50%) were rehospitalized for infection posttransplantation. Fifteen patients maintained 25%–50% of enteral nutrition before transplantation, and only one (1/15) was readmitted for infection. No patients who maintained >50% enteral nutrition (0/10) were readmitted due to infection after LT.

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  Fig. 3 Readmission rate due to infection after liver transplantation (LT) according to enteral nutrition. Among patients maintaining <25% enteral nutrition before transplantation, the readmission rate for infection was 50%. However, among patients maintaining ≥25%, only 4% were readmitted due to infection after LT.

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