Introduction ESPEN states that under-nutrition is a major factor influencing outcomes after orthotopic liver transplant (OLT). Early detections and interventions to correct nutritional deficits may help shorten length of hospital stay (LOS) post OLT.
Aim To determine if there is a relationship between nutritional parameters pre OLT and i) total LOS post OLT ii) intensive care (ICU) LOS post OLT. The primary outcome measures were total hospital LOS and ICU LOS. Secondary aims included measuring the degree of malnutrition in those with and without a cancer diagnosis as aetiology for OLT.
Method The study design was retrospective analysis. Approval was received from the hospital audit committee. All patients who were alive at discharge after an elective first OLT between January 2009 and December 2014 were identified. Data was prospectively gathered when nutritional status was assessed within 100 days pre transplant by a Dietitian. Data was retrospectively analysed on the following nutrition parameters; 1) dry BMI at OLT 2) hand grip strength (HGS) 3) Royal Free Hospital Global Assessment (RFH-GA). Statistical analysis including descriptive statistics, Spearman’s Correlation and the Mann-Whitney test to compare groups were undertaken.
Results 226 patients underwent their first elective OLT and survived to discharge. 76% of the patients were transplanted for decompensated cirrhosis and 24% for cancer. The incidence of malnutrition as defined by RFH-GA was 64% pre OLT.
The median BMI and%HGS of all OLTs was 25 Kg/m2[n = 200, range 15.1–41.1] and 75% [n = 84, range 28–151] respectively. The relationship between BMI and LOS had a weak negative association [r= –0.17, n = 200, p = 0.014]. Specifically patients with a BMI < 20 had a longer overall LOS compared to those with BMI >20 [21 days VS 17 days, p = 0.009]. The relationship between HGS pre OLT and LOS had a weak negative association [r= –0.247, n = 84, p = 0.024]. Specifically patients with a HGS <85% had a longer overall LOS compared to those with HGS greater or equal to 85% [19 days VS 16 days, n = 84, p = 0.02]. No association was found between HGS or dry BMI at OLT and ICU LOS.
Pre transplant malnutrition was more prevalent in those transplanted for decompensated cirrhosis compared to those with cancer (75% VS 8%). The LOS for decompensated cirrhosis was longer than that for cancer [18 VS 15.5days, n = 226, p = 0.017].
Conclusion The study would indicate that malnutrition as defined by BMI <20 or HGS < 85% of population norms is associated with a longer hospital stay post liver transplant but not ICU LOS. Dietetic resources should be targeted to these patients pre liver transplant.
Disclosure of interest None Declared.
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