Resolving Malnutrition with Parenteral Nutrition Prior to Liver Transplant in Biliary Atresia.

Objective: Malnutrition is a common complication of end-stage liver disease (ESLD) associated with poor liver transplant outcomes. Nasogastric feeds are used for nutritional supplementation, but some patients remain malnourished. Parenteral nutrition (PN) can be effective, but has potential complications. The primary objective was to evaluate the effect of PN on anthropometric measures in children with ESLD awaiting liver transplant. Secondary objectives were evaluation of PN associated complications, liver function tests, PELD scores, waitlist time, and post-transplant length of stay (total and time in the intensive care unit). Methods: A single-center, retrospective chart review analyzing pediatric patients with ESLD receiving PN who were transplanted over a 6-year period. Data were trended and described over time, as were the relationships between anthropometric data and time receiving PN. Results: 44 patients with ESLD were transplanted between January 2010 and December 2015. 18 (41%) received PN before transplant; all had biliary atresia with median age at transplant of 10 months (range, 5-18 months). Mid-upper arm circumference and triceps skinfold thickness showed resolution of malnutrition in 7 patients (39%) with normalization of one measure in another 4 patients (22%). Of the remaining, 6 had improved z-scores and one had worsening malnutrition. No deaths occurred in patients receiving PN. Central line infection rates were 3.8/1000 catheter days with 8 total infections in 6 patients over a total of 2117 catheter days. Conclusions: Children with ESLD and malnutrition who have failed enteral feeding may benefit from PN to improve and/or resolve malnutrition prior to liver transplant. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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