Organ Transplant Nutrition

indications for organ transplant

decompensated end stage organ failure

benefits of transplantation must outweigh the risks

result in longer life expectancy

contraindication for organ transplant

active infection , sepsis, malignancy, multisystem organ failure, active substance abuse, lack of social support

BMI and mortality liver transplant

worse transplant survival rates in those w obesity in study in 90s

recent research shows BMI doesn’t have much of an affect

meta analysis found no difference in survival for <25 or >35 BMI, no change in mortality

BMI and mortality kidney transplants

higher BMI associated with higher mortality risk of kidne transplant recipients

BMI and mortality heart transplants

survival rate decreases most in BMI 35+

studies showed 12% increase in mortality for those with 30-35 BMI

obesity and other comorbidities make them ineligible for transplant

immunosuppressive medication

prevent and treat rejection of transplant

side effect: hyperglycemia, hyperkalemia, hyperlipidemia, hypertension, hypomagensemia, nephrotoxicity, nausea, vom, GI, diarrhea, mucositis/stomasitis

immunosuppresive medication list

cyclosporine, tacrolimus, sirolimus

immunosuppressive cant be taken with

grapefruit, pomegranate, seville oranges, starfruit

preparing for a transplant

manage symptoms of end stage organ failure

maintain/improve overall nutrition statue

organ allocation through UNOS

united network for organ sharing, private non profit within US gov, manages US organ system

makes new organ transplant system, awards points based on categories

organ preservation times

acute post transplant

immunosuppression must be achieved to avoid rejection of organ

nutritional goals are to meet needs for fighting any potential infections , protein for energy /healing, energy for pt to be in rehab

chronic post transplant

physicians continue to monitor for rejection (fever, tender, labs)

nutrition goals to prevent/treat complications

-stress, effect of immunosuppressive drugs

glucose changes

corticosteroid use can lead to insulin resistance

calcineurin inhibitors can inhibit insulin release leading to high circulating glucose

new onset diabetes after transplant NODAT

hyperglycemia can lead to ^ inflammation & infection

corticosteroid

can lead to insulin resistance bc they ^ the production of glucose by the liver, so there is more circulating glucose

calcineurin inhibitor

inhibit insulin release, leads to high circulating glucose

lipid changes

corticosteroids and other anti-rejection meds can lead to hyperlipidemia

insulin resistance leads to more liver uptake of FFA leads to ^ VLDL production (later LDL)

insulin resistance leads to decreased breakdown of circulating TGs

protein changes

corticosteroids induce body protein breakdown LBM

proteins need to heal wounds, anastomes

protein needs post transplant

protein rec post transplant 1.5-2g/kg/d dry

chronic post transplant goes to 1g/kg (if still using corticosteroids)

calorie needs

not typically hypermetabolic unless other conditions exist (infection, sepsis)

if pt history of malnutrition, ^ calorie needs

absorptive capacity important for small bowel transplants

small bowel transplant indication

due to irreversible intestinal failure

small bowel transplant due to

short bowel sysndrome, issues related to short bowel causing decreased life expectancy

chronic intestinal pseudo obstruction: chronic motility disorder

non metastasizing tumors only in abdomen

small bowel transplant rejection

rate is very high, less hospitals do it due to the risk

pts receive TPN until bowel function is regained