Nutrition Status pre Liver Transplant and Length of Hospital Stay post Liver Transplant

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1 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

2 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):

3 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

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

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

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

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

8 Patient Profile BMI Kg/m 2 HGS % Age LOS ICU LOS n=200 n=84 n=22 6 n=226 n=226 Median Range

9 Correlation % HGS and LOS r s = p= 0.02

10 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

11 Correlation BMI at OLT and LOS r s = p= 0.008

12 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)

13 RFH-GA Status & Length of Stay post OLT (n=44) Figure 3: Median Length of Stay (days) days 15 Days days 15 days RFHGA Severely malnourished RFHGA Moderately Malnourished RFHGA Well Nourished 5 0 RFHGA Severely malnourished RFHGA Moderately Malnourished RFHGA Well Nourished Trend towards increased LOS for malnourished patients

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

15 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)

16 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

17 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.

18 Future Work Nutrition status pre OLT and Mortality post OLT Correcting for severity Liver disease (MELD) Males VS Females

19 Any Questions?