Nutrition Status pre Liver Transplant and Length of Hospital Stay - - PowerPoint PPT Presentation

Nutrition Status pre Liver Transplant and Length of Hospital Stay post Liver Transplant

• N. O’Sullivan, D D. Houlihan,

National Liver Transplant Unit St Vincent’s University Hospital, Dublin 4

Background

• ESPEN states that under-nutrition is a major factor

influencing outcomes after orthotopic liver transplant (OLT)1

• In SVUH use multimodal approach to assess nutrition status:

dry BMI, hand grip strength, mid arm muscle circumference, dietary intake. Is there a relationship between nutrition status pre transplant and length of hospital stay after transplant ?

1Plauth M et al, ESPEN Guidelines on Enteral Nutrition: Liver disease: Clinical Nutrition. 2006;25(2):285-94.

Aims

• Examine relationship between nutritional status

before Liver Transplant and i) total length of hospital stay (LOS) post OLT ii) intensive care (ICU) LOS post OLT.

• Measure the degree of malnutrition in those with

and without a malignant aetiology for OLT

Methods

Target Population

N= 226

• All First elective OLTs

alive at discharge Jan 2009-Dec 2014

Anthropometry

within 100 days pre OLT

• Hand Grip Strength

(HGS) n= 84

• Royal Free Hospital

Global Assessment nutrition score n= 44

Dry BMI on day of OLT n=200 Measure LOS and ICU LOS post OLT

Differences in

nutrition score between OLTs for cancer VS decompensated liver disease

Statistical Analysis

Royal Free Hospital Global Assessment Tool

Morgan et al (2006)

Methods

Target Population

N= 226

• All First elective OLTs

alive at discharge Jan 2009-Dec 2014

Anthropometry

within 100 days pre OLT

• Hand Grip Strength

(HGS) n= 84

• Royal Free Hospital

Global Assessment nutrition score n= 44

Dry BMI on day of OLT n=200 Measure LOS and ICU LOS post OLT

Differences in

nutrition score between OLTs for cancer VS decompensated liver disease

Statistical Analysis

Results

Profile of 1st elective Transplants that were alive at discharge

161

Male

(71%)

Gender

65

Female (29% )

Reason for Transplant

53 (23%) 173 (77%)

Cancer NON cancer

PBC/PSC Hep C NASH ALD Autoimmune CF Other Wilsons

31% ALD 24%

PBC/PSC

14%

Hep C

Patient Profile

BMI Kg/m

2

HGS % Age LOS ICU LOS

n=200 n=84 n=22 6 n=226 n=226

Median 25

75 55 18 1

Range

15.1- 41.1 28-151 19-70 8-164 0-30

Correlation % HGS and LOS

rs= -0.25

p= 0.02

Hand Grip Strength before OLT and Length of Stay Post OLT (n=84)

3 Day Difference Min 11, Max 164 Min 9, Max 60

(p=0.02)

19 days VS 16 days

Median 19 days Median 16 days

Correlation BMI at OLT and LOS

rs = -0.19

p= 0.008

BMI at OLT and Length of Stay (n=200)

Min 11, Max 67 Min 8, Max 81

4 Day Difference 21 days VS 17 days

(p=0.009)

RFH-GA Status & Length of Stay post OLT (n=44)

23 days 18 days 15 days

5 10 15 20 25

RFHGA Severely malnourished RFHGA Moderately Malnourished RFHGA Well Nourished

Figure 3: Median Length of Stay (days)

RFHGA Severely malnourished RFHGA Moderately Malnourished RFHGA Well Nourished

Days

Trend towards increased LOS for malnourished patients

Royal Free Hospital Global Assessment Nutrition Category

2 8% 23 92% WN

Severely Malnourished Moderately Malnourished Well Nourished

14 22% SMN 33 52% MMN 16 26% WN

Severely malnourished Moderately Malnourished Well Nourished

Cancer Eitiology for Transplant Non Cancer Eitiology for Transplant

ICU Length of Stay

• No association was found between any

nutritional parameter pre transplant and ICU LOS (HGS:2 days VS 1 day)

• No association was found between dry BMI at

OLT and ICU LOS post OLT (1day VS 1 day)

Limitations

• Does not correct for confounding factors
• Bias as HGS/ RFHGA not done on all patients

(data skewed as malnourished patients have more frequent measurements )

• Limited numbers for RFH-GA scores

Conclusion: Implications for Clinical Practice

• Patients with a dry BMI < 20 at time of Transplant stayed

in hospital longer than those with a BMI >20

• Patients who had a Hand Grip Strength <85% of

population norms within 100 days pre Transplant had a longer stay than those with a HGS>85%

• BMI or HGS was not associated with intensive care

length of stay post transplant

• Patients undergoing a transplant for Cholangiocarcinoma
• r hepatocellular carcinoma were better nourished than

those with a non cancer eitiology.

Future Work

• Nutrition status pre OLT and Mortality post

OLT

• Correcting for severity Liver disease (MELD)
• Males VS Females

Any Questions ?