Transplant Center - What's New
January 2008
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Nutrition and the Transplant Patient
The UK Transplant Center is placing a renewed emphasis on nutritional management for transplant candidates. Nutritional status is very important in patients awaiting a transplant, especially in endstage liver disease (ESLD) patients. Severe malnutrition prior to liver transplant can lead to the need for more blood products during surgery, an increased risk of infection after surgery, and ultimately a higher risk of graft failure and patient mortality. All of these lead to longer lengths of stay in the intensive care unit and the hospital. Due to the disease process of ESLD, the assessment of nutritional status can be difficult.
Typical methods of assessing nutritional status are hindered by fluid retention, ascites, hydration status and fluid overload. Some of the methods mentioned in the literature are subjective global assessment (SGA), anthropometrics, bioelectrical impedance analysis (BIA), and dual-energy X-ray absorptiometry (DEXA). SGA is the most widely used and trusted evaluation tool. It is based on present weight, height, nutritional history, changes on physical examination and existing medical conditions. It then classifies patients as being well nourished or as having mild, moderate or severe malnutrition.
When looking at treating nutritional status, it is important to maintain those who are not yet malnourished and to try to build up those who are malnourished before transplant. A common misconception is to restrict protein intake in patients with cirrhosis for fear of worsening encephalopathy. However, it is important to know that whether the goal is maintaining or building, you do not want to restrict protein. Calorie intake should be approximately 30 to 35 kcal/kg/day.
At the UK Transplant Center we have a registered dietitian on staff to help in the care of our patients. They are also available to consult with a patient to help them with their dietary needs.
In our next issue we will discuss another form of malnutrition that is many times not recognized as such in our part of the country—obesity and its treatment prior to transplant.
Outreach Nurse Liaison
University of Kentucky Transplant Center UK HealthCare and the Physician Liaison Program has added a nurse liaison serving Eastern Kentucky and West Virginia.
Linda Hays, RN, has more than 17 years of nursing experience. She has worked as an emergency department nurse and most recently worked with the Kentucky/West Virginia Organ Donor Affiliates (KODA).
Working with physicians throughout the region, Linda arranges for pretransplant testing at local hospitals and helps make sure the results get to the UK transplant physicians. Linda lives in the area, so she is on hand to counsel patients through the pretransplant evaluation. At the direction of the patient’s physician, Linda will go to the hospital, meet with the patient, and then discuss the case with Dinesh Ranjan, MD, chief of UK’s transplant section.
Dr. Ranjan has had an outreach clinic in Ashland, Ky., twice a month for several years. At the clinic he evaluates patients referred to him who may require a liver, kidney-pancreas or kidney transplant. The UK transplant team also has monthly clinics in Ashland and Huntington for potential lung and heart patients.
Dr. Ranjan conceived of the nurse liaison position because he recognized the need for a health care professional with clinical experience and knowledge of UK’s transplant service in the region.
Linda is part of UK HealthCare’s Physician Liaison Program, which now has five liaisons assisting physicians and allied health professional throughout the region. The liaison program works closely with UK•MDs, our physician call center. To refer a patient to any specialty or to learn more about UK HealthCare and the liaison program, call UK•MDS at 1-800-888-5533. You may also contact Linda directly by calling 606-624-5552.
Transplant Team Reaches Milestone with 400th Liver Transplant
On Dec. 19, the UK transplant team performed the University of Kentucky’s 400th liver transplant. The surgery was done by Dr. Dinesh Ranjan, director of the liver and pancreas program. This milestone is a sign of the continued growth of the transplant program, particularly thanks to the participation of the physicians in Kentucky and surrounding areas who refer patients for these life-saving procedures.
For more information on referring a patient, contact UK•MDs at 1-800-888-5533.
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