Thread by @GasBugZa

Next is Tanna Michel, a registered dietician, who will speak on 'Perioperative Nutrition in Transplant Patients', talking specifically about liver transplant patients.
#CCSSA2022 #critcare #FOAMcc

This patient cohort has a very high rate of malnutrition, as a result of a hypercatabolic status, decreased nutrient absorption and decreased caloric intake. There is a resulting negative energy balance.
10.3390/nu9101126
10.3748/wjg.v22.i4.1513
#CCSSA2022

Malnutrition and sarcopaenia are related to negative outcomes, hence timely nutritional assessment and advice needs to be incorporated to their care preop, periop, and postop.
#CCSSA2022

Nutritional status assessment can be particularly difficult in this patient population. Weight is inaccurate due to fluid retention, albumin is inaccurate due to decreased production. More complex assessments (MUAC, dry weight, etc) that are individualised are better.
#CCSSA2022

Nutrition before transplant requires early aggressive nutritional rehabilitation. Protein avoidance can be a problem, due to misconceptions by the lay person and professionals as well. 1.2-1.5g/kg/d of protein is recommended. #CCSSA2022

Branched chain amino acids are amino acids that do not require the liver for metabolism. They may have a role in this patient cohort, though this has not been incorporated into guidelines.
#CCSSA2022

Postoperatively, there is generally a worsening of protein-energy malnutrition post transplant. Caloric and protein requirements remain high for up to a year.
#CCSSA2022