The liver is one of our most important organs that converts what we eat into nutrients that your body can use, produces blood clotting factors, enzymes and other proteins, stores energy sources such as iron, vitamins and fats, and cleans toxic substances such as drugs and alcohol that may be harmful to our body.
The liver has the ability to regenerate itself, but in some cases it becomes irreversibly damaged. This can occur as a result of hereditary abnormalities, excessive alcohol and drug use, and infectious viruses that cause hepatitis. Cirrhosis is when the liver shrinks and hardens and the formation of large and small spots on it. Liver cirrhosis can cause fatal consequences such as jaundice, ascites formation, bleeding, accumulation of toxic wastes and coma. In such cases of liver failure, liver transplantation is a life-saving method.
Liver transplantation occurs in two ways; liver transplantation from cadaver and liver transplantation from living donor.
Cadaveric Liver Transplantation:It can be performed after the families of people who develop brain death due to reasons such as traffic accidents, brain hemorrhage, heart attack, donate their organs. The examinations must show that the organ donor does not have any infectious disease, cancer or liver disease. It is accomplished by transplanting the liver, which is surgically removed under appropriate conditions and preserved in special preservation fluids, to the recipient through another surgery. Unfortunately, since organ donations from cadavers are extremely rare in our country, there are long waiting lists.
Liver Transplantation with Living Donor:Surgery performed with a piece of liver taken from relatives of people with liver disease and in need of organ transplantation.
*The lower limit for liver donation is 18 years of age and the upper limit is 60 years of age.
LIVER TRANSPLANTATION AND NUTRITION
Nutrition is an integral part of the treatment during the transplantation process. Malnutrition is quite common in the pre-transplantation period. Although it is difficult to evaluate nutritional status with traditional methods due to metabolic abnormalities caused by the disease, preoperative Recovery interventions are indispensable to improve post-transplant outcomes.
Because medical problems differ between the acute recovery and chronic care phases after transplantation, nutritional requirements and nutritional treatments differ between these two periods. Nutritional therapy in the acute period after transplantation aims to promote recovery. Long-term nutritional and pharmaceutical treatments after transplantation are aimed at preventing and treating common problems such as obesity, diabetes, hyperlipidemia, hypertension and osteoporosis. Nutritional goals and treatments should be individualized based on the specific complications experienced by each patient.
Factors That May Affect Nutritional Status
Liver Transplant patients must use immunosuppressive drugs such as tacrolimus, cyclosporine, and corticosteroids for the rest of their lives. Long-term use of these drugs may cause side effects such as increased appetite, high blood pressure, increase in blood lipids, diarrhea, and liver function disorders. When planning a diet, these risks should be taken into consideration.
Replacing the weight lost before liver transplantation by eating an adequate and balanced diet is an important factor for the recovery process, but patients often think that they are starting a new life after transplantation and thus increase their calorie intake too much. They increase it too much. This increase is particularly evident in patients who have severe dietary restrictions prior to surgery or who suffer from relevant gastrointestinal symptoms or anorexia. Studies have shown that the average calorie intake of patients before transplantation increased from 27 kcal/kg/day to 32 kcal/kg/day. It has been determined that there is a two-fold increase in fat intake.
The immunosuppressive drugs used have an increasing effect on appetite and fat storage. Although modern drugs have fewer side effects, they affect nutritional status. They can cause diabetes over time by causing an increase in blood sugar.
It is generally used in many patients. Blood potassium levels increase due to the nephrotoxicity of these immunosuppressant drugs. Therefore, it is very important to control potassium levels in the early post-transplant period and reduce or regulate potassium-containing foods. In the long term, this risk disappears.
Another effect of immunosuppressant drugs is hypomagnesemia. Patients usually take magnesium supplements, but this process may be accompanied by diarrhea. Patients should be encouraged to consume magnesium-rich food sources such as grains, legumes, fruits and green vegetables. At this point, it should not be forgotten that patients using immunosuppressant drugs are 15-20% more susceptible to foodborne infections, and the patient should be trained on food safety / food hygiene.
Nutrition in the Acute Period
The purpose of acute nutrition after liver transplantation; is to provide sufficient protein and energy to prevent protein degradation.
Since protein catabolism increases after the operation, patients should be given 1.5-2 g / kg of protein.
In cases where an indirect calorimeter container cannot be used to calculate energy needs, energy Approximately
25-30 kcal/kg can be taken.
It has been shown that starting enteral nutrition within 12 hours after the operation reduces postoperative viral infections and provides a better positive nitrogen balance. Tube feeding should start with a rate of 10-15 kcal/kg and increase depending on tolerance. Oral feeding is usually started on the 5th day after surgery, as the swallowing reflex recovers. Enteral nutrition support should not be discontinued until patients can fully meet their daily nutritional needs orally.
Nutrition in the Long Term
Weight gain is usually observed in the long term after transplantation. The medications used and the fact that the patient starts to feel better are effective in this case. Most of the weight gain occurs in the first 6 months. Continued weight gain contributes to hyperlipidemia, diabetes, obesity, hypertension and cancer. is also available. In this process, energy intake, which was increased in the acute postoperative period, should be returned to normal. To prevent water retention related to steroid treatment, daily salt consumption should not exceed 3 g.
Nutrition planning should be planned in accordance with the patient's specific condition, blood values and medications used.
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