[An evaluation of a protocol of postoperative nutritional support in patients who have had a liver transplant]
Despite the fact that the incidence of malnutrition in patients subjected to liver transplants is high, there are no definite criteria on the most appropriate postoperative nutritional support characteristics. The present study is a review of our experience with the administering of a diet base on: 1) proteic saving techniques up to enteral nutrition tolerance, and 2) total parenteral nutrition in the event of intolerance (foreseen or proven) to enteral nutrition. The type of nutritional support used and nutritional evaluation data, both during hospitalization in intensive care, were studied over a period of 557 days, in a series of 70 patients subjected to liver transplants. In 61.9% of the study days, parenteral nutritional support techniques had to be used. Enteral nutrition was possible during 18.9% of the study period in patients who had been discharged, compared to 1.8% in patients who needed further transplants or died (p less than 0.001). The elimination of nitrogen gradually increased up to day 9, and then fell. No positive nitrogenated balance was observed until day 13. Glucemia levels remained high during the whole evolutive phase. Seric albumin and transferrin levels were normal at first, and fell during week two. Seric prealbumin levels were within normal limits. Seric Mg and Cu were lower that the reference values during the first 15 days of evolution, where as Zn reached normal levels on day 15. Normal cholesterol values were only observed on day 8. Our results show the level of intolerance to enteral nutrition during the evolution of the patients and the need for using a more aggressive nutritional support.