Pre-Transplant Nutrition as a Catalyst for Post-Liver Transplant Recovery

Introduction: Malnutrition is estimated to be present in ~ 80% of patients with decompensated cirrhosis. It is a well-recognized complication but an under-addressed predictor in liver transplantation. The impact of pre-transplant nutritional status on post-transplant recovery remains insufficiently characterized. We hypothesize that baseline nutritional status is a significant predictor of post-transplant clinical trajectory.


Methods: We conducted 6-months prospective observational study involving hospitalized adults undergoing evaluation for liver transplantation. Nutritional status was assessed. Postoperative outcomes included ICU, ventilator, and total hospital length of stay.


Results: Of the 129 patients evaluated for liver transplantation, 41 proceeded to transplant. Among these, 72% met ASPEN criteria for malnutrition: 25% were classified as severely malnourished, 47% moderately malnourished, 16% at risk, and 13% well-nourished. The mean Model for End-Stage Liver Disease score was 33, and the mean age was 51 years (range: 23–73 years). The cohort was 51% female and 49% male. All transplanted patients exhibited low prealbumin levels, and the mean serum albumin on the day of transplant was 2.7 g/dL. Mortality accounted for 12% following transplantation.
Severe malnutrition patients experienced the longest hospital stays, averaging 44 days, compared to 24 days for those with moderate malnutrition, 35 days for those at risk, and 20 days for well-nourished individuals. ICU utilization followed a similar pattern, with severely malnourished patients requiring an average of 32 days in the ICU, compared to 6 days for moderately malnourished, 9 days for at-risk, and 10 days for well-nourished patients. Ventilator days, severely malnourished (average of 11 days), both moderate and at-risk groups (2-days), and 1 day for well-nourished patients. Patients with metabolic dysfunction-associated steatosis liver disease experienced significantly prolonged ICU and ventilator days.


Conclusions: Our study underscores malnutrition as a significant predictor of poor postoperative outcomes in liver transplantation, including prolonged hospital stays, increased ICU utilization, and extended ventilator dependence. Early nutritional optimization offers a critical opportunity to enhance transplant success.