PP064 - NUTRITIONAL PREHABILITATION IN TRANSPLANT-WAITLIST PATIENTS WITH END-STAGE LIVER FAILURE: A RETROSPECTIVE CASE SERIES

PP064

NUTRITIONAL PREHABILITATION IN TRANSPLANT-WAITLIST PATIENTS WITH END-STAGE LIVER FAILURE: A RETROSPECTIVE CASE SERIES

A. P. Sarac^1,*, U. Aydin²

¹Nutrition and Dietetics, ²General Surgery, Oncolive Clinic, Izmir, Türkiye

Rationale: Malnutrition and sarcopenia are prevalent in end-stage liver failure patients awaiting transplantation, independently worsening waitlist mortality. This study evaluated a structured nutritional protocol targeting hepatic synthetic function and muscle mass.

Methods: 18 transplant-waitlist patients (Model for End-Stage Liver Disease [MELD] 15–25; alcohol-related n=6, viral n=8, non-alcoholic steatohepatitis n=4) initiated the protocol; 14 completed 12 weeks (dropout: non-compliance n=3, death n=1). Nutritional risk: Royal Free Hospital Nutritional Prioritizing Tool. Skeletal muscle mass was assessed by multi-frequency bioimpedance (InBody) post-paracentesis or at dry weight. Targets: 1.2–1.5 g protein/kg/day, 30–35 kcal/kg/day. Protocol: (1) egg whites and hydrolyzed collagen for proximal absorption and gastrointestinal tolerability; (2) oral branched-chain amino acid supplementation (0.25 g/kg/day); (3) late evening carbohydrate snack (~200 kcal); (4) micronutrient repletion; (5) lactulose titrated to 2–3 bowel movements daily. Wilcoxon signed-rank test; no correction for multiple comparisons given exploratory design.

Results: Median achieved intake: 1.3 g protein/kg, 32 kcal/kg. Among completers, 12/14 (85.7%) improved. MELD decreased from 16 to 11 (p=0.001). Albumin increased from 2.6 to 3.3 g/dL (p=0.002), enabling diuretic tapering. Bilirubin decreased from 3.5 to 1.8 mg/dL (p=0.001). INR improved from 1.7 to 1.1 (p=0.002). Skeletal muscle mass increased from 22.5 to 24.1 kg (p=0.003). No encephalopathy or variceal bleeding occurred. Two patients with refractory ascites showed disease progression.

Conclusion: Nutritional prehabilitation was associated with significant improvements in MELD scores, synthetic markers, and muscle mass. These findings support prehabilitation as a waitlist strategy to bridge patients to transplantation. Prospective validation is needed.

Disclosure of Interest: None declared