Nutrition for transplant patients is categorized into the two stages of recovery - the first few weeks following and long-term. The worse a nutritional condition is prior to a transplant, the higher the risk of complications are after the transplant, and the more likely the patient will spend longer in the hospital. Patients who have undergone liver transplants have weakened immune systems and therefore must be extra careful not catch any type of infection.
The First Stage
During the first stage post-op, the body undergoes a process of muscular dissolution to release certain hormones. This stage is inevitable and therefore a decrease in a person’s nutritional health is expected. Feeding tubes are generally used during this stage until the patient can adjust to eating on his own. Due to the medications, the patient will be full relatively fast, and therefore it is important to make sure the patient has frequent, light meals which contain enough calories and proteins. Many times patients need to take dietary supplements. This first stage is important for the patient – he needs to rebuild any reservoirs that have dwindled due to the surgery. Nutrition can also help prevent metabolic problems.
The daily amount of calories recommended at this stage is higher than usual. On the one hand, the body needs a certain amount of calorie in order to overcome the post-op stress; on the other hand, food intake should be closely monitored in order to prevent unnecessary weight-gain. The amount of calories will be determined based on age, gender, weight and diet. Diet is determined with blood tests, weight changes, appetite, ability to eat and any digestive problems.
The amount of recommended protein for this stage is also higher than usual, to help fight the post-operative stress and prevent the loss of proteins. Recommended foods include milk, chicken, fish, turkey and eggs. Fat and carbohydrates will be decided upon based on the recommended caloric intake and the patient’s ability to absorb the fat.
For most cases, the amount of sodium needs to be carefully monitored. Due to the high dosage of steroids, salty foods should be avoided: olives, pickled vegetables, salt, soup powder, salty cheeses and salty snacks. Additionally, easily contaminated foods should be avoided as well (mayonnaise).
The Long-Term Treatment Plan
The second recovery stage following a transplant is a long-term plan to ensure the patient follows a proper nutritional plan. This way the patient will prevent dietary problems which may be caused by medications. The most common problems are obesity, high fat profile, hypertension, diabetes and osteoporosis. In planning a diet, the dietician will take the patient’s eating habits into consideration. The number of calories and amount of daily proteins will be determined based on the patient’s age, gender, weight, activities and will be lower than the first stage of recovery. Sodium will still be limited, but not as much as previously.
Dietary Problems as Side Effects to Medication
One of the most common side effects is obesity and weight gain, which itself can cause other complications and health problems. Weight gain is caused by the patient’s sudden appetite following the usage of steroids, lack of activity, and overeating. Therefore, it is important to follow a set diet plan and avoid eating foods such as fried foods, margarine, butter, cream, ice cream and chocolate. Choose low-fat foods instead. Lower the sugar intake and make sure to have set meals with a wide variety of foods. Drink a lot.
Patients should also prefer to eat foods that are rich in fiber, such as whole grain bread, brown rice and vegetables. Fibers make a person feel fuller longer, help normalize intestinal activity, cholesterol levels and weight. The diet helps normalize a person’s weight and prevent weight gain.
Hypertension is caused by obesity and as a side effect to cyclosporine. Dietary treatment includes losing additional weight and additional exercise; limiting sodium and including more fruits and vegetables in the daily diet.
- Diabetes or Glucose Intolerance
Diabetes or glucose intolerance can be caused by cyclosporine and steroids. Diet plans should be strictly followed and insulin injections should be included.
Bone density problems can occur as a complication of steroids. 1000-1500 mg of calcium is the recommended dose to maintain healthy bones. Calcium is found in dairy products, sardines, cabbage and legumes. See your physician about calcium supplements and other medications that prevent the dissolution of bones.
High levels of potassium in the blood can occur as a side effect of cyclosporine and can cause damage to the patient’s heart rate. Foods with high levels of potassium (to avoid): dill, parsley, mint, tomatoes, avocado, dried fruits, potatoes, citrus fruits and bananas.
This is another side effect of cyclosporine and can cause the muscles to contract. Foods rich with magnesium include: peanuts, nuts, legumes, green vegetables.
Written by Odelia Sasson, dietician, Ein Kerem