Introduction: Malnutrition is prevalent in recipients undergoing liver transplantation. However, the implication of nutritional status on morbidity and mortality remains unclear. This study aims to evaluate the impact of malnutrition on recipient outcomes.
Methods: A retrospective review of 390 adult recipients who underwent liver transplantation between January 2009 and June 2016 was performed. Recipients with fulminant liver failure or those requiring re-transplantation were excluded. A total of 321 recipients was analysed. Nutritional status was determined by the subjective global assessment (SGA) at wait-listing and at transplantation. Outcome measures comprised the development of infection within the index admission, rejection within 90-days, and biliary anastomotic strictures within 90-days, as well as readmission within 90-days, intensive care unit (ICU) length of stay (LOS), hospital LOS, and overall survival.
Results: Malnutrition (SGA-B & SGA-C) was identified in 67% of the recipients at wait-listing. Progressive decline in nutritional status was observed at transplantation (wait-list median 4.4-months), where 77% of the recipients were malnourished. Of these, 18% (n=58) were severely malnourished (SGA-C). Severe malnutrition at transplantation was associated with longer ICU LOS (147-hours vs 89-hours, p<0.01), longer hospital LOS (40-days vs 16-days, p<0.01) and increased incidences of infection (55.2% vs 33.8%, p<0.01) when compared to the well-nourished recipients (SGA-A). Other outcome measures were not associated with nutritional status.
Conclusion: This large study demonstrates the impact of malnutrition on early recipient morbidity. Nutritional interventions prior to transplantation may potentially improve outcomes and reduce the economic burden on our healthcare system.