The first-ever American Association for the Study of Liver Diseases (AASLD) Practice Guidance on the management of malnutrition, frailty and sarcopenia in patients with cirrhosis is now available. It was developed under the leadership of Jennifer C. Lai, MD, hepatologist at UC San Francisco.
Lai and a panel of other experts reviewed the published literature and incorporated their own clinical experience to build out comprehensive, pragmatic recommendations that can be applied immediately in clinical practice when treating patients with cirrhosis who present with these conditions.
“My research focuses holistically on the health and well-being of patients with chronic liver disease and cirrhosis, as assessed by nutritional status and muscle health,” said Lai. “Our team at the UCSF Liver Transplant Program has developed an index to help assess muscle health and identify patients who are the most vulnerable to poor outcomes, including death and low quality of life. Traditional research has focused on how to help patients survive. My team’s work is trying to advance our understanding of how to help them thrive.”
Until now, definitions of malnutrition, frailty and sarcopenia were not established for patients with cirrhosis. The new practice guidance provides definitions of these conditions as commonly represented in all populations partnered with operational definitions to use in clinical practice when caring for patients with cirrhosis. Most important, Lai and the co-authors provide clinicians with pragmatic guidance on managing these conditions in their patients.
Case study: focusing on nutrition and fitness in preparation for liver transplantation
The new AASLD Practice Guidance includes proven strategies that are being successfully applied in Lai’s practice. Susan, a 64-year-old woman, developed life-threatening complications of cirrhosis and was hospitalized multiple times to manage massive fluid retention, electrolyte disturbances and confusion. She became weaker after every admission and had lost significant muscle mass since her initial diagnosis. Her chances of survival were decreasing.
Susan and her family did not give up hope. At the UCSF Liver Transplant Program, Lai provided Susan with a personalized nutrition and exercise “prescription” that included a detailed regimen for improving her muscle health.
With her husband as her coach, Susan implemented the plan by closely monitoring her food intake and diligently performing the recommended exercises, even when she felt she couldn’t go on. At every visit to the UCSF Liver Transplant Program, Susan underwent objective testing of her functional status that enabled her to see her progress and feel motivated to continue. Within months of implementing Lai’s strategies, Susan successfully received her liver transplant and was discharged. She has since made a full recovery.
“Susan’s story highlights the importance of nutrition and fitness to outcomes in patients with cirrhosis awaiting liver transplantation,” Lai said. The new AASLD Practice Guidance details the nutrition and exercise strategies Lai provides for her patients, including Susan.
UCSF adult liver transplant survival rates exceed national average
UCSF’s adult liver transplant patients have a one-year survival rate that consistently exceeds the national average, according to the Scientific Registry of Transplant Recipients (SRTR). In SRTR's most recent reporting period, UCSF liver transplant recipients had a survival rate of nearly 97 percent one year after transplant, compared with a national average of 92.8 percent.
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