Role of the dietitian in the nutrition management of adults after liver transplantation.

Liver transplantation has become an increasingly common treatment for end-stage liver disease. In 1988, 1,680 liver transplantations were performed in the United States (1). The Transplant Department at Baylor University Medical Center (BUMC) in Dallas, Tex, has become one of the largest adult liver transplant centers in the United States and has an 84% 1-year patient survival rate. The program's success can be partially attributed to an interdisciplinary team approach. As part of this approach, a full-time registered dietitian was added to the Transplant Department in 1987 to provide specialized nutrition care to all liver transplant patients. A second full-time dietitian was added in 1991.

Role of the transplant dietitian

The role of the transplant RD is threefold: to assess the liver transplant patient's nutritional status and nutrition problems, to ensure that each patient receives appropriate nutritional intake, and to counsel all patients regarding their nutrition needs. A nutrition protocol developed at BUMC ensures thorough nutrition care for all liver transplant recipients.

Nutrition assessment of the liver transplant candidate

The initial step in the nutrition protocol is a nutrition assessment of the liver transplant candidate. Many common objective nutrition assessment parameters--including weight; serum albumin, transferrin, prealbumin, and retinol-binding protein concentrations; skin-test antigen measurements; total lymphocyte count; and 24-hour creatinine, 3-methylhistidine, and urine nitrogen excretion measurements--have limited use in the assessment of patients with end-stage liver disease (2-11). Therefore, a subjective nutrition assessment tool was developed at BUMC to assess liver transplant candidates.

The assessment tool was fashioned …