Improvement of nutritional status in malnourished cirrhotic patients one year after liver transplantation

Background & aims: Liver transplantation is a major procedure often undertaken in patients in poor nutritional status. Few studies have examined the modification of nutritional status after liver transplantation. We aimed at analyzing the modification of nutritional status occurring in liver recipients during the first year. Methods: Twenty-five consecutive patients submitted to liver transplantation were studied. A complete nutritional assessment, was performed before and at 3, 6 and 12 months after transplantation. Insulin and C-peptide plasma levels were determined and insulin sensitivity was estimated. Results: According to subjective global assessment 56% of patients were malnourished at transplant. In malnourished patients nutritional status further deteriorated at 3 months but improved 6 and 12 months after transplantation. Fat mass significantly increased from before to 12 months after transplant (median triceps skinfold: 10.8 vs 15.2 mm, p = 0.03) while parameters of muscle mass showed minor variations (median arm muscle circumference: 23.4 vs 24.0 cm, p = 0.3). The daily calorie intake also improved (27 vs 32 kcal/kg/die, p = 0.007) and protein intake increased (0.8 vs 1.3 g/kg, p = 0.02). In patients without malnutrition nutritional status and dietary intake showed minor variations after transplantation. Hyperinsulinemia was normalized and insulin sensitivity improved in all patients post-transplant. Conclusions: During the first 12 months after liver transplant a significant improvement in nutritional status is achieved in patients previously malnourished. Fat deposits show the more rapid improvement while the amelioration of muscle mass requires a longer period. The increased dietary intake and improved insulin sensitivity are associated to these changes. © 2011 European Society for Clinical Nutrition and Metabolism