Assessment of nutritional support in patients after liver and kidney transplantation

During the last decades organ transplantation has evolved into a proven therapy for end-stage organ failure. However, the long-term success of organ transplantation depends significantly on the patients’ ability to overcome possible postoperative complications and to recover from a severe metabolic imbalance. Therefore, in the present study we assessed the accuracy of the early post-operative nutritional intake in a vulnerable group of patients after organ transplantation and compared it with the calculated minimal nutritional requirements. A number of 61 patients were included in the study, 48 with liver, 11 with kidney, and two patients with both, liver and kidney transplants. Mini nutritional assessment (MNA) was applied and total nutritional intake was recorded for fourteen consecutive post-transplant days. Serum concentrations of proteins, urea and creatinine, as well as catalytic concentrations of liver enzymes were measured. Urea to creatinine ratio was calculated. According to body mass index (BMI) only a few patients were malnourished, but low serum protein levels indicated a significant protein catabolism. Nutritional requirements were provided mainly by glucose, with low amounts of proteins, i.e. amino acids, and fats. It took more than seven days to reach the appropriate nutritional intake. Because of the intensive catabolism, especially of proteins, nutrition of organ transplant recipients requires permanent monitoring and better nutritional support through formulas for enteral and total parenteral nutrition

Nutritional status and requirements in patients after liver and/or kidney transplantation

Prehrana bolesnika predstavlja važan segment u procesu lječenja. Odgovarajući unos energije i nutrijenata osigurava komponente nužne u procesima zarastanja, imunološkom odgovoru i normalizaciji metabolizma što čini sastavni dio lječenja i oporavka. Transplatacija organa je postupak kojim se značajno poboljšava prognoza u bolesnika s kroničnim bolestima jetre i bubrega, ali preoperativna pothranjenost, stres, katabolitam proteina, post-operativne komplikacije i razdoblje gladovanja imaju značajan utjecaj na uspjeh transplatacije. Cilj ovog istraživanja bio je odrediti nutritivni status pacijenata podvrgnutih transplataciji jetre i bubrega, te utvrditi u kojoj mjeri post-operativna prehrana zadovoljava potrebe pacijenata. Pored unosa energije i glavnih nutrijenata, proteina, ugljikohidrata i masti, od posebnog je interesa bio sastav masnih kiselina u serumu ispitanika i mogući nedostatak esencijalnih, višestruko nezasićenih masnih kiselina. U ispitivanju je sudjelovala 61 osoba kojoj je izvršena transplatacija organa. Od ukupnog broja pacijenata kod 48 je izvršena transplatacija jetre, kod 11 pacijenata transplatacija bubrega, a kod 2 pacijenta transplatiranan je i jetra i bubreg. Nutritivni unos detaljno je praćen tijekom prvih 14 dana nakon operacije. U prikupljenim uzorcima krvi izmjereni su osnovni biokemijski pokazatelji metabolizma jetre i bubrega, kao i parametri oksidativnog stresa. Provedena je ekstrakcija ukupnih lipida i sastav masnih kiselina određen plinskom kromatografijom. U serumu ispitanika nakon transplatacije utvđen je porast koncentracije lipida, a time i masene koncentracije masnih kiselina, dok se njihov međusobni odnos nije značajnije mijenjao. Izuzetak čini porast udjela oleinske kiseline. (OA, C18:1n-9) i smanjenja udjela linolenske kiseline (LNA, C18:3n-3), što se odrazilo i na porast omjera ukupnih n-6/n-3 višestruko nezasićenih masnih kiselina (PUFA). Prosječni dnevni nutritivni unos tijekom prvih 14 dana nedostatan je u većine pacijenata. Utvrđeno je prisustvo metaboličkog sindroma u 31,2 do 45,5% pacijenata, dok prisutnost oksidativnog stresa nije potvrđena. Rezultati ovog istraživanja omogućuju bolje sagledavanje nedostataka u postupku nutritivne podrške bolesnika i otvaraju mogućnosti da se promjenama u prehrani i/ili korištenjem odgovarajućih pripravaka za enteralnu i parenteralnu prehranu pozitivno utječe na brzinu i tijek oporavaka i tako skrati vrijeme te smanje ukupni troškovi lječenja.Nutritional status of patients is an important component of their healing and recovery process in the context of any illness. Adequate intake of energy and nutrients provides the necessary components in the process of healing, immune response and normalization of metabolism, all of which form an integral part of the treatment and recovery process. Organ transplantation is a procedure that significantly improves prognosis in patients with chronic liver disease and end stage renal disease. However, preoperative malnutrition, stress, protein catabolism, post-operative complications, and period of fasting during the early post-operative period, have a significant impact on the success of transplantation. The aim of this study was to determine the nutritional status of patients undergoing liver and kidney transplantation and to determine the extent to which early post-operative nutrition meets the needs of patients. In addition to the input of energy and major nutrients, protein, carbohydrates, and fats, of particular interest were the composition of fatty acids in the serum of patients and the possible lack of essential polyunsaturated fatty acids (PUFA). The study involved 61 participants with the liver and/or kidney transplantation. Of the total number of patients, 48 received liver transplant, 11 patients received a kidney transplant, and 2 patients received both, liver and kidney transplants. Their nutritional intake was closely monitored for 14 post-operative days. In collected blood samples basic biochemical indicators of liver and renal function as well as the indicators of oxidative stress were monitored. Total lipids were extracted, and the composition of fatty acids was analysed by gas chromatography. The results of serum analysis in post-transplant patients revealed the increased total lipid concentration as well as mass concentration of fatty acids, while the ratio of fatty acids did not change significantly. The exception was the increase in the ratio of oleic acid (OA, C18:1n-9) and the decrease in linolenic acid (LNA, C18:3n-3), which resulted in the increased ratio of total n-6/n-3 polyunsaturated fatty acids (PUFA). The average daily nutritional intake during the first 14 days is insufficient in the majority of patients. The metabolic syndrome was identified in 31.2 to 45.5% of patients, while the presence of oxidative stress has not been confirmed. The results of this study provide a better understanding of the nutritional deficiencies and requirements of patients with organ transplants. They can serve as the basis for changing postoperative algorithms that will allow better nutritional support by using appropriate preparations for enteral and parenteral nutrition, with the aim to improve the graft survival, decrease the time of hospitalization and recovery, and thus ultimately also decrease the overall costs of medical treatment

Nutritional status and requirements in patients after liver and/or kidney transplantation

Prehrana bolesnika predstavlja važan segment u procesu lječenja. Odgovarajući unos energije i nutrijenata osigurava komponente nužne u procesima zarastanja, imunološkom odgovoru i normalizaciji metabolizma što čini sastavni dio lječenja i oporavka. Transplatacija organa je postupak kojim se značajno poboljšava prognoza u bolesnika s kroničnim bolestima jetre i bubrega, ali preoperativna pothranjenost, stres, katabolitam proteina, post-operativne komplikacije i razdoblje gladovanja imaju značajan utjecaj na uspjeh transplatacije. Cilj ovog istraživanja bio je odrediti nutritivni status pacijenata podvrgnutih transplataciji jetre i bubrega, te utvrditi u kojoj mjeri post-operativna prehrana zadovoljava potrebe pacijenata. Pored unosa energije i glavnih nutrijenata, proteina, ugljikohidrata i masti, od posebnog je interesa bio sastav masnih kiselina u serumu ispitanika i mogući nedostatak esencijalnih, višestruko nezasićenih masnih kiselina. U ispitivanju je sudjelovala 61 osoba kojoj je izvršena transplatacija organa. Od ukupnog broja pacijenata kod 48 je izvršena transplatacija jetre, kod 11 pacijenata transplatacija bubrega, a kod 2 pacijenta transplatiranan je i jetra i bubreg. Nutritivni unos detaljno je praćen tijekom prvih 14 dana nakon operacije. U prikupljenim uzorcima krvi izmjereni su osnovni biokemijski pokazatelji metabolizma jetre i bubrega, kao i parametri oksidativnog stresa. Provedena je ekstrakcija ukupnih lipida i sastav masnih kiselina određen plinskom kromatografijom. U serumu ispitanika nakon transplatacije utvđen je porast koncentracije lipida, a time i masene koncentracije masnih kiselina, dok se njihov međusobni odnos nije značajnije mijenjao. Izuzetak čini porast udjela oleinske kiseline. (OA, C18:1n-9) i smanjenja udjela linolenske kiseline (LNA, C18:3n-3), što se odrazilo i na porast omjera ukupnih n-6/n-3 višestruko nezasićenih masnih kiselina (PUFA). Prosječni dnevni nutritivni unos tijekom prvih 14 dana nedostatan je u većine pacijenata. Utvrđeno je prisustvo metaboličkog sindroma u 31,2 do 45,5% pacijenata, dok prisutnost oksidativnog stresa nije potvrđena. Rezultati ovog istraživanja omogućuju bolje sagledavanje nedostataka u postupku nutritivne podrške bolesnika i otvaraju mogućnosti da se promjenama u prehrani i/ili korištenjem odgovarajućih pripravaka za enteralnu i parenteralnu prehranu pozitivno utječe na brzinu i tijek oporavaka i tako skrati vrijeme te smanje ukupni troškovi lječenja.Nutritional status of patients is an important component of their healing and recovery process in the context of any illness. Adequate intake of energy and nutrients provides the necessary components in the process of healing, immune response and normalization of metabolism, all of which form an integral part of the treatment and recovery process. Organ transplantation is a procedure that significantly improves prognosis in patients with chronic liver disease and end stage renal disease. However, preoperative malnutrition, stress, protein catabolism, post-operative complications, and period of fasting during the early post-operative period, have a significant impact on the success of transplantation. The aim of this study was to determine the nutritional status of patients undergoing liver and kidney transplantation and to determine the extent to which early post-operative nutrition meets the needs of patients. In addition to the input of energy and major nutrients, protein, carbohydrates, and fats, of particular interest were the composition of fatty acids in the serum of patients and the possible lack of essential polyunsaturated fatty acids (PUFA). The study involved 61 participants with the liver and/or kidney transplantation. Of the total number of patients, 48 received liver transplant, 11 patients received a kidney transplant, and 2 patients received both, liver and kidney transplants. Their nutritional intake was closely monitored for 14 post-operative days. In collected blood samples basic biochemical indicators of liver and renal function as well as the indicators of oxidative stress were monitored. Total lipids were extracted, and the composition of fatty acids was analysed by gas chromatography. The results of serum analysis in post-transplant patients revealed the increased total lipid concentration as well as mass concentration of fatty acids, while the ratio of fatty acids did not change significantly. The exception was the increase in the ratio of oleic acid (OA, C18:1n-9) and the decrease in linolenic acid (LNA, C18:3n-3), which resulted in the increased ratio of total n-6/n-3 polyunsaturated fatty acids (PUFA). The average daily nutritional intake during the first 14 days is insufficient in the majority of patients. The metabolic syndrome was identified in 31.2 to 45.5% of patients, while the presence of oxidative stress has not been confirmed. The results of this study provide a better understanding of the nutritional deficiencies and requirements of patients with organ transplants. They can serve as the basis for changing postoperative algorithms that will allow better nutritional support by using appropriate preparations for enteral and parenteral nutrition, with the aim to improve the graft survival, decrease the time of hospitalization and recovery, and thus ultimately also decrease the overall costs of medical treatment

Slagalica nasljeđa : priručnik za opismenjavanje iz medicinske genetike

"Slagalica nasljeđa" - priručnik za opismenjavanje iz medicinske genetike ima tri namjene. Prije svega, on je edukativna slikovnica za studente, liječnike i pacijente, ali i druge zainteresirane pojedince jer su u njoj kroz ilustracije objašnjene osnove genetike čovjeka, kao i osnove medicinske genetike. Od toga kako prepoznati osobu s genetičkim poremećajem, kako nastaju i koje vrste genetičkih poremećaja postoje pa sve do toga na koji ih način možemo dijagnosticirati. Nadalje, nakon svake ilustracije na pojedinoj stranici nalaze se definicije 79 pojmova iz medicinske genetike koje čine tezaurus za studente, liječnike i pacijente koji se na bilo koji način susreću s genetičkim poremećajima. Naposljetku, ova knjiga sadrži i primjere rečenica u koje su ubačeni stručni pojmovi iz medicinske genetike, a koji su namijenjeni studentima prilikom savladavanja komunikacijskih vještina na kolegiju Medicinska genetika, ali i liječnicima prilikom informiranja svojih pacijenata o (mogućem) genetičkom poremećaju. Uz kreatoricu ideje i urednicu izdanja, doc. dr. sc. Ninu Perezu, autori izdanja su studenti šeste godine Integriranog preddiplomskog i diplomskog sveučilišnog studija Medicina i prof. dr. sc. Saša Ostojić

Slagalica nasljeđa : priručnik za opismenjavanje iz medicinske genetike

"Slagalica nasljeđa" - priručnik za opismenjavanje iz medicinske genetike ima tri namjene. Prije svega, on je edukativna slikovnica za studente, liječnike i pacijente, ali i druge zainteresirane pojedince jer su u njoj kroz ilustracije objašnjene osnove genetike čovjeka, kao i osnove medicinske genetike. Od toga kako prepoznati osobu s genetičkim poremećajem, kako nastaju i koje vrste genetičkih poremećaja postoje pa sve do toga na koji ih način možemo dijagnosticirati. Nadalje, nakon svake ilustracije na pojedinoj stranici nalaze se definicije 79 pojmova iz medicinske genetike koje čine tezaurus za studente, liječnike i pacijente koji se na bilo koji način susreću s genetičkim poremećajima. Naposljetku, ova knjiga sadrži i primjere rečenica u koje su ubačeni stručni pojmovi iz medicinske genetike, a koji su namijenjeni studentima prilikom savladavanja komunikacijskih vještina na kolegiju Medicinska genetika, ali i liječnicima prilikom informiranja svojih pacijenata o (mogućem) genetičkom poremećaju. Uz kreatoricu ideje i urednicu izdanja, doc. dr. sc. Ninu Perezu, autori izdanja su studenti šeste godine Integriranog preddiplomskog i diplomskog sveučilišnog studija Medicina i prof. dr. sc. Saša Ostojić