Early postoperative tube feeding in liver transplantation

Abstract

We published one of the first prospective randomized controlled trials evaluating early postoperative tube feeding (TF) in liver transplant recipients nearly 20 years ago. That first study showed that early posttransplant TF was safe and well tolerated; the study results also suggested that early TF could reduce posttransplant infection rates. This Pivotal Paper review evaluates the past, present, and future of early postoperative TF in liver transplantation. This article identifies what nutrition support findings more than 2 decades ago were the basis for attempting postoperative TF in liver transplantation. The results of our study, its unique findings, and shortcomings are summarized. Other subsequent studies of post-liver transplant TF are evaluated with a focus on effects on posttransplant infection rates. Finally, current transplant challenges, including donor organ shortage, increased severity of patients' pretransplant condition, expansion of living donor options, changes in immunosuppression, and use of specialized nutrients, are discussed in the context of how and why these factors affect nutrition support. © 2014 American Society for Parenteral and Enteral Nutrition.