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 ? 1 Plauth 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 • All First elective OLTs alive at discharge Population Jan 2009-Dec 2014 N= 226 • Hand Grip Strength (HGS) n= 84 Anthropometry • Royal Free Hospital within 100 days pre OLT Global Assessment nutrition score n= 44 Differences in Dry BMI on nutrition score day of OLT between OLTs for cancer VS n=200 decompensated liver disease Measure LOS Statistical and ICU LOS Analysis post OLT

Royal Free Hospital Global Assessment Tool Morgan et al (2006)

Methods Target • All First elective OLTs alive at discharge Population Jan 2009-Dec 2014 N= 226 • Hand Grip Strength (HGS) n= 84 Anthropometry • Royal Free Hospital within 100 days pre OLT Global Assessment nutrition score n= 44 Differences in Dry BMI on nutrition score day of OLT between OLTs for cancer VS n=200 decompensated liver disease Measure LOS Statistical and ICU LOS Analysis post OLT

Results Profile of 1 st elective Transplants that were alive at discharge Gender Reason for Transplant 65 53 (23%) Female (29% ) Cancer 173 161 (77%) Male (71%) NON cancer 24% PBC/PSC PBC/PSC Hep C 14% NASH ALD 31% Hep C Autoimmune ALD CF Other Wilsons

Patient Profile BMI HGS % Age LOS ICU Kg/m LOS 2 n=200 n=84 n=22 n=226 n=226 6 Median 25 75 55 18 1 15.1- 28-151 19-70 8-164 0-30 Range 41.1

Correlation % HGS and LOS r s = -0.25 p= 0.02

Hand Grip Strength before OLT and Length of Stay Post OLT (n=84) Median 19 days Median 16 days 3 Day Difference Min 11, Max 164 Min 9, Max 60 (p=0.02) 19 days VS 16 days

Correlation BMI at OLT and LOS r s = -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) Figure 3: Median Length of Stay (days) 25 23 20 days RFHGA Severely 18 malnourished 15 days 15 Days RFHGA Moderately days Malnourished 10 RFHGA Well Nourished 5 0 RFHGA Severely RFHGA Moderately RFHGA Well malnourished Malnourished Nourished Trend towards increased LOS for malnourished patients

Royal Free Hospital Global Assessment Nutrition Category Cancer Eitiology for Transplant Non Cancer Eitiology for Transplant 14 2 22% 16 8% SMN 26% WN 23 Severely Severely 33 malnourished 92% Malnourished Moderately 52% WN Moderately Malnourished MMN Malnourished Well Nourished Well Nourished

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 or 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

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