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THE IMPACT OF NUTRITIONAL STATUS ON PREDICTION OF OUTCOME IN PATIENTS AWAITING AND FOLLOWING LIVER TRANSPLANTATION

M Zeman, G Meerberg, D Belland, V Bain, D Bigam, P Grover, K Gutfreund, N Kneteman, A Mason, J Shapiro, W Wong, M Ma
University of Alberta, Edmonton, Alberta

Pre-operative malnutrition is associated with post-liver transplant morbidity and mortality. Despite this, nutrition is not being considered in the Model of End-Stage Liver Disease (MELD) score. MELD is known to correlate with both mortality pre-transplant as well as short-term mortality post-transplant. Subjective Global Assessment (SGA) is a validated and reliable assessment model of nutritional assessment. The goal of the study was to determine if SGA could predict outcome in patients awaiting and following transplantation; specifically, deaths while waiting for transplant, and minor and major post-transplant complications including length of mechanical ventilation and ICU and/or hospital stay, as well as the frequency of post-operative infections, acute rejection and survival.
We retrospectively reviewed 207 sequential adults who underwent liver transplant assessment at the University of Alberta between 2003-present. Of these 207 patients, 41 died awaiting transplant, lack of information was available for 14 and 15 were removed from analysis because the indication for transplant was fulminant liver failure. This left 137 patients who underwent liver transplantation for non-fulminant liver disease. SGA was used to classify patients into 3 groups: well-nourished (class A), mildly malnourished (class B) and severely malnourished (class C). SGA score was then correlated with MELD score and need for pre-transplant hospitalization and post-transplant outcome. In these 137 patients, we removed 17 patients from analysis because the indication for transplantation was hepatocellular cancer.
Our analysis showed that MELD score was predictive of death in SGA A patients but was not as good a predictor of death in SGA B&C patients. The severity of SGA or MELD, by itself, was not associated with duration of ICU or hospital stay. However, patients with a high MELD and SGA B or C status had more complications, including a longer ICU or hospital stay.
Moderate and severe malnutrition increases mortality in patients awaiting liver transplant and morbidity in patients after liver transplant. Systemic assessment of nutrition and intense nutrition support should be provided to all patients waiting for liver transplantation.

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