Malnutrition in children with chronic liver disease accepted for liver transplantation : clinical profile and effect on outcome

Shepherd, R. W., Chin, S. E., Cleghorn, Geoffrey J., Patrick, M., Ong, T. H., Lynch, S. V., Balderson, G., & Strong, R. (1991) Malnutrition in children with chronic liver disease accepted for liver transplantation : clinical profile and effect on outcome. Journal of Paediatrics and Child Health, 27(5), pp. 295-299.

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The nutritional profiles of 37 children (aged 0.5-14.0 years) with chronic liver disease at the time of acceptance for orthotopic liver transplantation (OLTP) have been evaluated using clinical, biochemical and body composition methods. Nutritional progress while waiting for a donor has been related to outcome, whether transplanted or not. At the time of acceptance, most children were underweight (mean standard deviation (s.d.) weight = -1.4 ± 0.2) and stunted (mean s.d. height = - 2.2 ± 0.4), had low serum albumin (27/35) and had reduced body fat and depleted body cell mass (measured by total body potassium - mean % expected for age = 58 ± 5%, n = 15). Mean ad libitum nutrient intake was 63 ± 5% of recommended daily intake (RDI). Those who died while waiting (n = 8) had significantly lower mean initial s.d. weight compared with those transplanted. The overall actuarial 1 year survival of those who were transplanted (mean waiting time = 75 days) was 81% but those who were initially well nourished (s.d. weight >-1.0) had an actuarial 1 year survival of 100%. There were no significant differences in actuarial survival in relationship to age, type of transplant (whole liver or segmental), liver biochemistry or the presence or absence of ascites. Of the total group accepted for OLTP, whether transplanted or not, the overall 1 year survival for those who were relatively well nourished was 88% and for those undernourished (initial s.d. weight <-1.0) was 38% (P<0.003). Declining nutritional status during the waiting period also adversely affected outcome. We conclude that malnutrition and/or declining nutritional status is a major factor adversely affecting survival in children awaiting OLTP. In transplant units where waiting time is greater than 40 days, earlier referral, prioritization of cases and the use of adult donor livers may reduce this risk and efforts to maintain or improve nutritional status deserve further study.

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ID Code: 90263
Item Type: Journal Article
Refereed: Yes
Additional Information: Cited By :57
Export Date: 1 September 2015
Keywords: adolescent, article, child, child nutrition, chronic liver disease, clinical article, human, infant, liver transplantation, malnutrition, priority journal, Child Nutrition Disorders, Child, Preschool, Chronic Disease, Female, Liver Diseases, Male, Prognosis, Survival Rate
ISSN: 1034-4810
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Exercise & Nutrition Sciences
Deposited On: 17 Nov 2015 00:25
Last Modified: 17 Nov 2015 00:25

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