Assessing Nutritional Risk of the Post-Acute Liver Transplant Population

Background. Although nutritional deficiency is known to be both common and multifactorial in the post-liver transplant population, a global systematic method of assessing nutritional status has not been widely implemented. The Subjective Global Assessment has been validated in many clinical populations, but to this investigator's knowledge there are no reports on its use in the post-acute liver transplant population. The purpose of this Doctorate of Nursing Practice project was to assess nutritional risk using a Nutritional Assessment Tool, consisting of the Subjective Global Assessment plus additional indicators, for use in the post-acute liver transplant population, defined as one week or less after hospital discharge from liver transplant. The additional indicators consist of age, body mass index, Model for End-Stage Liver Disease score, hospital length of stay for liver transplant, and diagnosis of diabetes mellitus. Methods. This was a practicality study in which a Nutritional Assessment Tool was administered by advanced practice nurses to post-acute liver transplant patients in an outpatient clinic. Each advanced practice nurse completed a practicality survey. Dependence of the additional indicators on the Subjective Global Assessment classification was evaluated using ANOVA and Fisher's exact test. Time to administer the tool was also collected. Results. Seventeen participants were enrolled over a period of three months. Among these, 70.5% were ranked as well-nourished, 23.5% as moderately malnourished, and 5.9% as severely malnourished. No statistically significant dependence of the indicators on the Subjective Global Assessment classification was found. The average time to administer the tool was 9.7+/- 2.4 minutes. Based on the survey from advanced practice nurses, the Nutritional Assessment Tool was found to be practical in this outpatient clinic setting. Conclusions. Implementing a Nutritional Assessment Tool, or the Subjective Global Assessment at minimum, in the post-acute liver transplant population in this setting served to be a practical method of evaluating global nutritional risk