After Transplant

Nutrition Following Liver Transplantation

Nutrition Support

Nutritional support following liver transplantation is an essential part of the recovery process at Cincinnati Children's Hospital Medical Center.

Immediately after surgery, your child will not receive any food by mouth (this is called "NPO"). Instead, a special liquid food mixture is provided through the blood via an intravenous catheter (IV). The mixture -- called total parenteral nutrition (TPN) or hyperalimentation -- contains protein, carbohydrates, fat, vitamins and minerals.

Total parenteral nutrition usually starts on day one or day two after the transplant surgery. Oral feedings start after bowel function has returned. Your child starts with a clear liquid diet and advances, as he or she can tolerate, to a regular diet appropriate for your child's age and development. Infants put on special formula before transplant usually can be returned to regular formula.

Tube Feeding

Occasionally it may be necessary to supplement your child's regular diet with tube feedings if your child is unable to eat enough to provide enough calories for optimal nutrition. Your child's nutritional needs can be met through tube feedings for as long as needed. Often, tube feeding is used for just a short time. Then the tube is removed when the child is able to eat normally and meet post-operative nutritional requirements.

Assessing Nutritional Needs

Each transplant patient has individual nutritional needs as determined by the transplant team dietitian. Nutritional status will be reassessed daily while your child is in the hospital, and his or her diet will be altered as needed. When your child begins eating, we will keep careful records of the amount of food and fluid he or she consumes. If oral intake remains below goals, we will encourage high-calorie, high-protein foods or supplements. A diet technician will work with your child to determine food preferences. The dietitian will discuss your child's nutritional needs with you throughout the hospital stay.

Before your child is discharged from the hospital, the dietitian or diet technician will discuss the appropriate diet for the age of your child. Upon discharge, proper nutrition continues to play an important role in the recovery process by providing the nutrients your child needs to grow and build a strong body. Food supplies the everyday requirements to grow, play, learn, and stay active and healthy. Offering a variety of foods is the best way to supply the nutrition your child needs.

Healthy Snacking

Snacks are an important part of childhood nutrition. Three meals and two to three snacks per day help children meet their high-energy needs. Encourage snacks of nutritious foods such as fresh fruit, vegetables, cheese, yogurt, peanut butter, graham crackers, pretzels, cereals and animal crackers. Remember, children learn by watching others, so be sure to set a good example by eating well-balanced meals and snacks.

Fast foods are generally high in fat, sugar and salt. As long as children regularly get the proper nutrients at other meals and snacks, an occasional stop for fast food does no harm. However, be aware of the high sugar and caffeine content of most soft drinks, and encourage your child to drink milk, water or fruit juice instead.

Common Nutrition-Related Problems

Fluid and Salt Retention

This problem may cause:

Swelling of your child's hands, ankles and abdomen
A sudden increase in body weight
Heightened blood pressure

Restrict the use of table salt and foods that are naturally high in salt content such as lunch meat, hot dogs, bacon, sausage, canned soup, most snack foods and foods containing monosodium glutamate (MSG). Read package labels carefully and follow your dietitian's guidelines.

Muscle Weakness After Surgery

This problem is related in part to the steroids that your child takes post-transplant. Steroids increase your child's need and desire for protein. Protein is essential to the diet and is important for growth, building strong body tissues and wound healing. Include high-protein, low-fat foods such as lean beef, fish, poultry without the skin and low-fat dairy products in your child's diet.

High Blood Sugar (Hyperglycemia) After Surgery

Blood sugar or glucose is produced by the breakdown of sugar and starches. Sugar provides the energy your child's body needs for daily activities. When a part of the body needs energy, glucose is transported to that area by a chemical called insulin. The steroids your child takes limit insulin's activity, so glucose is not transported and used, resulting in high blood sugar levels. If this occurs, the dietitian will advise you on the proper diet guidelines to maintain blood sugar levels.