Dietician - Nutritian Before Your Transplant

Prior to your transplant, it is important to maintain good nutrition to maximise your health and aid recovery.  The Dietician is available to assist you with your eating program or any problems you may have

The goals of nutritian therapy during the wait for transplantation are

1. To replenish malnourished patients

2. To maintain the status of those with adequate muscle and energy reserve

3. To promote weight loss in patients with excessive weight based on body mass index (BMX)

4. To manage patients' symptoms to maximise quality of life.

A dietitian will evaluate your current nutritional status. He or she will ask you to describe your eating habits before you came to the hospital, including any problems you had or special diets you followed. The dietitian will measure your body fat and muscle mass and evaluate your lab tests.

Then he or she will set up an individual diet plan with recommendations for improving your diet and your overall physical condition before surgery. The goal of this nutritional plan is to help prepare you for surgery, to make your recovery faster, and to decrease the number of complications that could result from poor nutrition.

Causes and Incidence of Malnutrition

Heart

Malnutrition has been reported in 45% of patients awaiting heart transplant; these patients are at risk for developing cardiac cachexia. The specific form of PEM is thought to be caused by anorexia and hypermetabolism attributable to increased cardiac and respiratory workload. These patients display depleted visceral protein stores in addition to loss of fatty tissue and lean body mass. Adequate nutrition to achieve and maintain optimal nutritional status before transplantation is essential to reduce the postoperative length of stay and morbidity and mortality rates.

When nutritional repletion is required, 35-40 calories per kg and 1.5-2 grams of protein per kg may be needed. Diet recommendations must be individualized to the specific patient to provide energy-dense nutritional supplements as needed to meet energy requirements and to restrict fluid or sodium only when necessary. If weight loss is required to attain a BMI of less than 27 kg/m², calories should be restricted by 500 per day to promote 1 pound of weight loss per week. Encourage exercise as tolerated to promote loss of fatty tissue while maintaining lean muscle mass. The encouragement of exercise applies to all adults awaiting transplantation, particularly those who need to lose weight because of an excessive BMI.

Lung

The incidence of malnutrition among patients with lung disease varies depending upon the etiology of their disease. Those with increased breathing work (eg, those with emphysema, cystic fibrosis, and other types of bronchiectasis) appear to be the most hypermetabolic and have the greatest incidence of malnutrition In patients with cystic fibrosis, malnutrition may also be due to chronic lung infections and malabsorption. Poor oral intake due to early satiety, edema, and ascites from intra-abdominal pressure, in addition to hypoxia contributing to anorexia, lead to an increased incidence of malnutrition.

When nutrition repletion is required, 35-40 calories per kg and 1.5-2.0 grams of protein per kg may be required. Frequent ingestion of small portions of energy-dense foods and supplements can help patients achieve optimal oral nutrition. If patients cannot consistently meet increased nutritional demands, they may benefit from enteral nutrition supplementation. BMI in lung transplant candidates appears to be a more accurate predictor of risk for short-term complications than percent ideal body weight. The most appropriate BMI in this patient population has yet to be determined.

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