Protein intake early after liver transplantation and postoperative outcome: An observational study comparing two nutritional protocols

Objectives: Patients undergoing liver transplantation (LT) are at risk for eating difficulties. Adequate nutritional support is important to promote enhanced recovery and to reduce postoperative complications. The aim of this study was to evaluate two nutritional protocols and their effect on total protein intake during the first 7 d after LT.

Methods: Adult patients were monitored daily for energy and protein intake during the first week after LT. Patients with ≥3 d of monitoring were included in the study. Two patient groups were studied: protocol A (pA) based on enteral nutrition (EN) provided from postoperative days 1 through 4 (historical control); and protocol B (pB), which was based on high volume of EN and high-protein oral nutritional supplements (ONS). Outcome measures were hospital length of stay and grade of complications according to Clavien-Dindo within the first 3 mo after transplantation.

Results: Seventy patients were included in the study (pA n=34, pB n= 36). The median age was 59 y and 70% were men. During postoperative week 1, patients with pB had a higher daily protein intake (95 g versus 77 g, P < 0.01) and met a higher proportion of estimated protein requirements (80% versus 70%, P < 0.05). There were no differences in severe postoperative outcomes between the two groups.

Conclusions: A nutritional protocol with a higher rate of EN and high-protein ONS resulted in a higher protein intake early after LT. However, there was no difference in severe postoperative outcomes between the two nutritional protocols.