Nutritional factors affecting growth before and after liver transplantation.

Malnutrition is present in approximately 60% of children at the time of liver transplantation. The pathogenesis of malnutrition is complex and includes reduced calorie intake, fat malabsorption, abnormal nitrogen metabolism, and increased energy expenditure leading to increased calorie requirements. As nutritional status at transplantation is a significant factor in both morbidity and mortality post liver transplantation, intensive nutritional support pre-transplant is vital and may be achieved with a modular feed providing 120-150% estimated average requirement (EAR). Approximately 80% of children who survive liver transplantation will achieve normal growth and nutritional status within 12 months post-transplant. Significant factors responsible for growth failure post-transplant include pre-operative nutritional status (height SDS score <-2), continued glucocorticoid administration, recurrent hepatic dysfunction or chronic rejection and reduced calorie intake due to behavioural feeding problems. Effective future strategies include intensive pre- and post-operative nutritional support and early reduction of glucocorticoid administration.