Feasibility of Early Oral Nutritional Supplementation After Liver Transplantation: A Randomized Pilot Study

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-04-03 DOI:10.1111/ctr.70524

Amal Trigui, Crystèle Hogue, Mélanie Tremblay, Geneviève Huard, An Tang, Justine Racette, Christopher F. Rose, Chantal Bémeur

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Abstract

ABSTRACT

Catabolic and inflammatory changes after liver transplantation (LT) increase energy and protein requirements. This study assessed the feasibility of a 12-week high-energy/high-protein oral nutrition supplementation (ONS) initiated after resumption of solid oral intake post-LT. Secondary objectives were 1) to describe changes in nutritional risk, muscle strength, and quality of life during the pre-transplant period, and 2) to explore the potential impact of ONS after LT on these outcomes and muscle mass.

Methods

In this randomized feasibility study, patients awaiting LT were assessed for nutritional risk (Liver Disease Under nutrition Screening Tool), muscle strength (Chair Stand Test, CST), and quality of life (SF-36) before LT, every three months until surgery, at discharge, and again at 12 weeks post-LT. Muscle mass was assessed by CT scan at LT admission and 12 weeks later. After LT, participants were randomized to a control group or an intervention group receiving ONS for 12 weeks. Feasibility outcomes included eligibility, recruitment and target sample size, adherence to the protocol and intervention, attrition, and safety.

Results

Of the seven predefined feasibility criteria, four were met, two were partially met (eligibility and recruitment rates), and one was not met (target sample size rate). Fifty-five patients were followed before LT, 17 underwent LT, and 14 were analyzed. Six patients developed new-onset diabetes after LT, limiting randomization to three patients in the intervention group and five in the control group. Before LT, 85.5% (47/55) of included patients were at risk of malnutrition, which remained stable during waiting time (p = 0.418), while muscle strength declined (p = 0.039). At 12 weeks post-LT, the intervention group had 0% malnutrition risk and a median CST time of 11.5 s, compared with 60% and 15.1 s, respectively, in the control group. The prevalence of sarcopenia did not change before and after the intervention.

Conclusion

Early post-LT ONS was feasible regarding adherence, retention, and safety; however, recruitment and achieving the targeted transplanted sample size were major barriers. The study highlights the high prevalence of malnutrition and sarcopenia before and after LT.

Practitioner Points

Early post-transplant nutritional supplementation showed feasibility for 4 of the 7 evaluated criteria.
Most patients (85.5%) awaiting liver transplantation are at risk of malnutrition, with low and declining muscle strength during the waiting period.
Challenges in participant recruitment suggest that refined recruitment approaches are needed for larger-scale studies.

Abstract Image

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肝移植术后早期口服营养补充的可行性：一项随机试点研究。

肝移植（LT）后的分解代谢和炎症变化增加了能量和蛋白质需求。本研究评估了lt后恢复固体口服摄入后开始12周高能/高蛋白口服营养补充（ONS）的可行性。次要目标是：1)描述移植前营养风险、肌肉力量和生活质量的变化；2)探讨移植后ONS对这些结果和肌肉质量的潜在影响。方法：在这项随机可行性研究中，等待肝移植的患者在肝移植前每三个月评估一次营养风险（营养下肝病筛查工具）、肌肉力量（椅子站立测试，CST）和生活质量（SF-36），直到手术，出院时，肝移植后12周再次评估。在LT入院时和12周后通过CT扫描评估肌肉质量。LT后，参与者被随机分为对照组或接受ONS治疗的干预组，为期12周。可行性结果包括资格、招募和目标样本量、对方案和干预的依从性、减员和安全性。结果：在预定义的7项可行性标准中，4项满足，2项部分满足（合格率和招募率），1项不满足（目标样本量率）。肝移植前随访55例，行肝移植17例，分析14例。6例患者在肝移植后出现新发糖尿病，限制了干预组3例和对照组5例患者的随机分组。LT前85.5%（47/55）患者存在营养不良风险，在等待时间内营养不良风险保持稳定（p = 0.418），而肌力下降（p = 0.039）。在lt后12周，干预组的营养不良风险为0%，中位CST时间为11.5秒，而对照组分别为60%和15.1秒。肌少症的患病率在干预前后没有变化。结论：早期lt后ONS在依从性、保留性和安全性方面是可行的；然而，招募和实现目标移植样本量是主要障碍。该研究强调了移植前后营养不良和肌肉减少症的高发率。医生指出：移植后早期营养补充在7个评估标准中有4个是可行的。大多数等待肝移植的患者（85.5%）存在营养不良的风险，在等待期肌力低且不断下降。在参与者招募的挑战表明，更大规模的研究需要完善的招募方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.