MNT for Organ Transplant

Question 1

What type of organ transplant is the most common?

Answer 1

Kidney

Question 2

What is the indication of organ transplantation?

Answer 2

Decompensated end-stage organ failure

Question 3

What are some examples of diseases in which organ transplants are indicated?

Answer 3

-End-stage liver disease
-End-stage renal disease
-Congestive heart failure
-Respiratory failure due to COPD or CF

Question 4

What are some contraindications of organ transplant?

Answer 4

-Active infection or sepsis
-Multisystem organ failure
-Active substance abuse
-Advanced age
-Frailty
-Severe obesity
-Lack of social support post-transplant
-Poor prognosis

Question 5

In the pre-transplant phase, the goals of MNT are…

Answer 5

-Optimize nutritional status as much as possible prior to transplant
-Alleviate complications caused by organ failure

Question 6

Many patients awaiting transplant are _____, and this can cause higher rates of post-transplant morbidity and mortality

Answer 6

Malnourished

Question 7

Medical concerns in the 1st 2 months after transplant include…

Answer 7

-Rejection
-Infections

Question 8

Nutrition concerns for the 1st 2 months post-transplant:

Answer 8

-Provide adequate nutrition to replete stores, heal surgical wounds, and fight infections
-Food-drug interactions of immunosuppressive regimen

Question 9

Food-drug interactions of Cyclosporine:

Answer 9

-Avoid grapefruit
-Hypomagnesemia
-Hyperkalemia
-Hyperglycemia
-Hypertension
-Hyperlipidemia

Question 10

Food-drug interactions with Tacrolimus (Prograf):

Answer 10

-Avoid grapefruit (causes elevated levels)
-Hypomagnesemia
-Hyperkalemia
-Hyperglycemia
-Hypertension
-N/V

Question 11

Food-drug interactions with Azathioprine (Imuran):

Answer 11

-Macrocytic anemia
-N/V
-Mouth sores
-Acute pancreatitis

Question 12

Food-drug interactions with corticosteroids (like Prednisone):

Answer 12

-Hyperglycemia
-Sodium retention
-Hyperphagia (increased hunger)
-Weight gain
-Hypertension
-Muscle wasting and weakness
-Impaired wound healing
-Osteoporosis

Question 13

Energy needs for acute/immediate post-transplant:

Answer 13

30-35 kcal/kg

Question 14

Protein needs for acute/immediate post-transplant:

Answer 14

1.5-2.0 g/kg

Question 15

Fluid needs for acute/immediate post-transplant:

Answer 15

Individualize based on fluid status, organ function, and fluid loss

Question 16

Calcium needs for acute/immediate post-transplant:

Answer 16

1200 mg/d

Question 17

After transplant, patients should advance as tolerated to a _____ diet, considering any MNT for comorbidities

Answer 17

Regular

Question 18

If someone has fluid retention, recommend a ____ gram sodium diet and possible fluid restriction

Answer 18

2

Question 19

If someone has hypoglycemia, recommend a ___-___ diet

Answer 19

Carbohydrate-controlled

Question 20

After transplant, patients should take a ____ with minerals and oral nutrition supplements if needed

Answer 20

Multivitamin

Question 21

If someone is intubated or has a poor appetite, they might need ____ ____

Answer 21

Enteral nutrition

Question 22

If someone needs enteral nutrition post-transplant, they should get a ____ ____ formula

Answer 22

High nitrogen (protein)

Question 23

If someone has fluid overload, they should get a _____ formula

Answer 23

Concentrated

Question 24

If someone is one enteral nutrition, we should monitor…

Answer 24

-Nutritional intake
-Weight
-Labs: serum glucose, serum electrolytes
-Fluid status
-Wound healing

Question 25

In the chronic post-transplant phase, what are some common nutrition concerns?

Answer 25

-Weight gain and obesity -Hyperglycemia (drug-induced DM) -Hyperlipidemia -HTN -Electrolyte imbalances -Micronutrient deficiencies -Osteoporosis

Question 26

Goals of MNT for chronic post-transplant phase:

Answer 26

-Ensure adequate nutrition -Prevent or treat complications

Question 27

In the chronic post-transplant phase, recommend calories to promote healthy ____ ____

Answer 27

Body weight

Question 28

Protein needs for chronic post-transplant:

Answer 28

1 g/kg

Question 29

Someone in the chronic post-transplant stage should take a ____ with minerals

Answer 29

Multivitamin

Question 30

Someone in the chronic post-transplant stage should get ____ mg/day of calcium

Answer 30

1200

Question 31

What should we monitor in the chronic post-transplant stage?

Answer 31

-Weight -Dietary intake -Labs

Question 32

Diet education for someone in the post-transplant stage should include...

Answer 32

-Heart Healthy diet -Additional diet recommendations as needed -Food safety

Question 33

Food safety precautions:

Answer 33

-Avoid raw protein foods and rare meat -Thaw perishable foods in the fridge -Avoid using cracked eggs -Wash fruits and vegetables -Use only pasteurized milk and cheese -Cook to appropriate internal temperatures -Adhere to the expiration dates on labels -Wash hands before handling food