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Korean J Transplant 2020; 34(1): 38-46

Published online March 31, 2020

https://doi.org/10.4285/kjt.2020.34.1.38

© The Korean Society for Transplantation

Poor preoperative enteral nutrition would be a risk factor for readmission due to infection after liver transplantation

Kyung Won Seo1,2, Kwang Il Seo2,3, Hye Min Ha2, Jee Young Lee2, Young Il Choi1,2, Hyung Hwan Moon1,2, Ki Hyun Kim1,2, Yeon Myung Shin1,2, Yong Seok Park2,4, Hyuk Rae Cho2,4

1Department of Surgery, Kosin University College of Medicine, Busan, Korea
2Nutritional Support Team, Kosin University Gospel Hospital, Busan, Korea
3Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
4Department of Neurosurgery, Kosin University College of Medicine, Busan, Korea

Correspondence to: Kwang Il Seo
Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea
Tel: +82-51-990-5205
Fax: +82-51-990-5055
E-mail: bupiertree@gmail.com

Received: January 7, 2020; Revised: February 17, 2020; Accepted: February 21, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Most patients who undergo liver transplantation (LT) have advanced cirrhosis and poor nutritional status. The aim of this study was to investigate the effect of enteral nutrition (EN) on the clinical outcomes after LT.
Methods: From 2015 to 2019, the medical records of recipient of LT at Kosin University Gospel Hospital were retrospectively reviewed.
Results: Thirty-seven patients underwent LT. Nineteen patients underwent living donor liver transplantation (LDLT) and 18 patients underwent deceased donor liver transplantation (DDLT). One LDLT patient was excluded because transplantation was done within 1 month. Five DDLT patients were excluded either because they died within 1 month (n=4) or received transplantation within 1 month. (n=1). Therefore, 31 patients were analyzed. Psoas-muscle index (P=0.715) and serum albumin (P=0.111) were not statistically different between the LDLT and DDLT groups. Four patients (4/31) were readmitted because of infection. One LDLT patient was diagnosed with genitourinary infection. The three DDLT patients were diagnosed with pulmonary tuberculosis (n=1), diverticulitis (n=1), and sepsis (n=1). Readmission caused by infection was not statistically different between LDLD and DDLT patients (P=0.284). Preoperative EN <25% of the recommended amount (P=0.016) was significantly associated with readmission related to infection. In multivariate analyses, preoperative EN <25% was an independent risk factor for readmission due to infection after LT regardless of psoas-muscle index, baseline Model for End-Stage Liver Disease score, or LT type.
Conclusions: Preoperative poor EN is significantly associated with readmission risk due to infection within 3 months of LT.

Keywords: Liver transplantation, Enteral nutrition, Infection, Psoas-muscle index

HIGHLIGHTS
  • • Resumption of oral nutrition within 12 hours after liver transplantation (LT) has been shown to reduce postoperative viral infection and maintain adequate nitrogen balance.

  • • In addition, our study revealed that preoperative poor enteral nutrition (EN) was significantly associated with readmission risk due to infection within 3 months of LT.

  • • Therefore, patients who are preparing for liver transplantation should be encouraged to maintain adequate EN to reduce risk of infection and readmission after liver transplantation.