Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction: Protein-calorie malnutrition is common in patients with advanced liver disease and is a risk factor for poor outcomes after liver transplantation (LT). Perioperative parenteral nutrition (PN) use has conventionally been limited, due to concerns for increased risk of catheter-related bloodstream infections (BSI), as well as graft cholestasis and dysfunction. Herein outcomes of high MELD LT recipients requiring PN to supplement > 20% of daily caloric needs as determined by indirect calorimetry are described and compared with those who did not.
Methods: An IRB-approved retrospective chart review was undertaken for 204 consecutive LT recipients transplanted between January 2013 and June 2015. MELD scores, postoperative intensive care unit (ICU) and overall length of stay (LOS) were analyzed by t-test. Chi-square and log-rank tests were utilized to compare disposition and survival, respectively, between PN recipients and non-PN recipients.
Results: Of the 204 recipients, 107(52%) were PN users and 97 were non-PN users. The median MELD score at LT for PN users was 36 vs. 18 for non-PN (p<0.0001). Post-LT ICU LOS and overall LOS were longer with PN use (p<0.0001). Though PN was not prescribed on discharge, disposition was more likely to be to a rehabilitation or skilled nursing unit for PN users than for non-PN users(p<0.0001). In no instance was PN discontinued due to graft dysfunction, and graft loss was rare in both cohorts. Lastly, despite higher incidences of 30-day BSI rate in PN users (p=0.004), there was 0% BSI-related mortality and no difference in 1-year patient survival compared to non-PN users (p=0.89).
|PN users||Non-PN users||p-value|
|Post-LT ICU LOS||Median 14 days||Median 3 days||<0.0001|
|Overall LOS||Median 24 days||Median 10 days||<0.0001|
|Discharge to facility||67.9%||20.8%||<0.0001|
|1-year graft loss||2||1|
|1-year patient survival||91.0%||89.1%||0.89|
Conclusion: Despite the higher acuity of LT recipients requiring PN, graft loss is a rare complication, and 1-yr patient survival is equivalent to non-PN users. With meticulous perioperative care, malnourished high MELD LT recipients with indications for PN may receive needed nutritional support and demonstrate equivalent excellent outcomes.
CITATION INFORMATION: Liang D, Gordon Burroughs S, Nolte J, Boktour M, Ensor J, Ali A, Hirase T, Hall J, Spear S, Moore L, Mobley C, Saharia A, Hai S, Gaber A, Ghobrial R. Utilization of Parenteral Nutrition in Patients Undergoing Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Liang D, Burroughs SGordon, Nolte J, Boktour M, Ensor J, Ali A, Hirase T, Hall J, Spear S, Moore L, Mobley C, Saharia A, Hai S, Gaber A, Ghobrial R. Utilization of Parenteral Nutrition in Patients Undergoing Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/utilization-of-parenteral-nutrition-in-patients-undergoing-liver-transplantation/. Accessed March 9, 2021.
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