Northwestern Memorial Hospital
Patient Education
ABOUT YOUR SURGERY
Nutrition and Physical Evaluation before
Liver Transplant Surgery
If you have
questions ask
your doctor or
nurse.
You and your care team will work together to help you be
prepared for liver transplant surgery. Part of this process includes
an evaluation of your nutritional health and physical fitness. This
brochure describes:
■ Your Pre-Transplant Clinic evaluation
■ Setting goals to improve your nutrition and physical condition
■ Ways to improve your nutrition and physical health
Being in the best health possible before your transplant surgery
will help your recovery. By improving your nutritional and physical
health, you will:
■ Decrease your risk for infection after your transplant
■ Increase your strength and energy
■ Heal better after surgery
Pre-Transplant Clinic Visit
Your care team will work with you during your visits to the pre-transplant clinic. During your
first visit to the clinic, they will check your health status with the following measurements
and exams.
Height and Weight
We will check your height and weight at each visit. Then we can calculate your body mass
index (BMI) which measures body fat based on your height and weight. The dietitian will ask
you about your weight history (gains and losses).
Diet
You will be asked to describe your food intake from the last 24 hours (24-hour food recall).
Physical Exam
The dietitian will ask you questions about your health to get more information about your
nutrition. They will check for:
■ Fluid intake
■ Swelling and fluid retention
■ Muscle loss
■ Gastrointestinal problems.
Timed Up and Go Test
At each clinic visit a member of the transplant team will have you complete a timed up
and go test. The timed up and go is a simple test to assess your mobility. You will be
asked to start from a sitting position, stand and walk 15 feet.
A physical therapist may also check your physical strength and ability based on your
performance with the timed up and go test.
Grip Strength
At each clinic visit a member of the transplant team will test your grip strength using a
dynamometer. A dynamometer is a tool that you squeeze with your dominant hand. It
measures the power of your grip. Your results will give your care team a picture of your
overall muscle strength.
Setting Goals
Nutrition Goals
The registered dietitian will use these results to make a plan that will improve the quality
of your diet. They will work with you to set diet and nutrition goals. This will help ensure
that you get the right amount of calories and protein you need to include in your diet
each day. (See Appendix 1: Nutrition Goals.) Good nutrition will help you be in the best
possible health for your transplant surgery.
Activity Goals
The physical therapist will work with you to set activity goals that will improve your
physical fitness. (See Appendix 2: Activity Goals.)
Improving Your Nutrition
The liver filters all of the nutrients you eat in foods and beverages. The liver also stores
the energy your body needs during periods of fasting (overnight). When the liver is
damaged, waste products build up in the blood and its ability to store energy is limited.
It is important to follow a healthy, balanced diet because it can help manage some
complications of liver disease. The following may be some of the suggestions from your
registered dietitian to improve your nutrition. Your diet may be modified depending on
your specific diet needs.
Small Frequent Meals
The goal is to eat 4 to 6 small meals a day. You can improve your nutrition by eating
meals high in calories, nutrients, and protein every 2 to 3 hours. The goal is to eat 250 to
350 calories at each small meal. (See Appendix 3: 6 Small Meals Menu Sample.)
Increase Protein
Protein is a nutrient needed for normal growth, wound healing, and fighting infections.
Eat your protein source before other items during a meal. For example, eat eggs before
toast. Try to eat 10 to 20 grams of protein at each of the 6 small meals. (See Appendix 4:
Food Sources of Protein.)
2
Increase Calories
Calories give your body the fuel it needs. Foods such as carbohydrates can give you
those extra calories. Some carbohydrates include:
■ Grains (whole grain bread, brown rice, whole grain pasta)
■ Beans (lentils, chickpeas)
■ Starchy vegetables (winter squash, potatoes, corn, peas)
■ Fruit (apples, grapes, oranges)
■ Low-fat dairy products (low-fat or 1% milk; low-fat, plain yogurt)
You can add extra calories to your diet through:
■ High-calorie evening snacks – A snack of 300 to 500 calories (aim for more than
50 grams of carbohydrates) will help to improve muscle mass. Enjoy a late evening
snack to avoid fasting from dinner to breakfast. (See Appendix 5: Sample Snack
Recipes.)
■ Calorie-containing beverages – Some people may benefit from drinking caloriecontaining beverages such as milk, 100% fruit juice, lemonade, smoothies or
nutritional supplements. Talk to your dietitian to see if this option is right for you.
Nutrition Drinks
There are several types of nutritional drinks that can supplement your diet. Your dietitian
will help you choose the ones that are right for you. Some examples include:
■ Ensure®
■ Boost®
■ Carnation Instant Breakfast®
■ Nepro®
Avoid drinks with no nutritional value, such as soda, diet soda and alcohol.
Limit Water During Meals
To avoid feeling full, do not drink a full cup of water 30 minutes before a meal. To allow
good digestion, wait 30 minutes after a meal before drinking water.
Add Vitamins and Minerals
Follow your doctor’s advice for adding vitamins and mineral supplements to your diet.
Nutritional Support
If you are unable to eat or you are not eating enough, your care team may suggest tube
feedings. Tube feedings can supply your body with the nutrition you need to be healthy
for your transplant. If needed, your care team will talk to you about this option.
Para asistencia en español, por favor llamar al Departamento de Representantes para Pacientes al 312.926.3112.
The entities that come together as Northwestern Medicine are committed to representing the communities we serve, fostering a culture of inclusion, delivering
culturally competent care, providing access to treatment and programs in a nondiscriminatory manner and eliminating healthcare disparities. For questions, please
call either Northwestern Memorial Hospital’s Patient Representatives Department at 312.926.3112, TDD/TTY 312.926.6363, the Northwestern Lake Forest Patient
Relations manager at 847.535.8282 and/or the Northwestern Medical Group Patient Representatives Department at 312.695.1100, TDD/TTY 312.926.6363.
Developed by: NMH Kovler Organ Transplantation Center- Liver Transplant Team
©October 2016 Northwestern Memorial HealthCare
900320 (10/16) Nutrition and Physical Evaluation before Liver Transplant Surgery
Appendix 1: Nutrition Goals
Current Status
Date:
Current Weight
Current Grip Strength
Current Meal Pattern
Type��������������������������������
How many meals per day���������������
Size of meals�������������������������
Other�������������������������������
Current Timed Up and Go
Intermediate Goals
Date:
Weight
Grip Strength
Meal Pattern
Timed Up and Go
Long-Term Goals
Date:
Weight
Grip Strength
Goal – Men: More than 30 kg (66 pounds)
Goal – Female: More than 20 kg (44 pounds)
Meal Pattern
4 to 6 Small Frequent Meals
Calories per day����������������������
Protein per day�����������������������
Other�������������������������������
Timed Up and Go
Goal – Less Than 11 Seconds
Appendix 2: Activity Goals
Date
Up to Chair
for Meals
(3 times per day)
Walking
(30 minutes a day)
Arm Exercises
Leg Exercises
(number of repetitions) (number of repetitions)
Appendix 3: 6 Small Frequent Meals – Sample Meal Plan
Breakfast
• Cooked oatmeal (1 cup)
• Dried cranberries (1/4 cup)
• 2% Milk (1 cup)
Meal total: 350 calories
• Protein: 13 grams (g)
• Sodium: 125 milligrams (mg)
• Carbohydrate: 61 g
Mid Morning Meal
• Whole wheat bread (1 slice)
• Peanut butter (1 Tablespoon)
• Jelly (1 Tablespoon)
• Baby carrots (5)
Meal total: 240 calories
• Protein: 7 g
• Sodium: 225 mg
• Carbohydrate: 33 g
Lunch
• Grilled chicken breast (3 ounces)
• Salad greens (1 cup) with 2 tsp olive oil
and 1 tsp vinegar
• Pear (1 small)
Meal total: 323 calories
• Protein: 27 g
• Sodium: 432 mg
• Carbohydrate: 27 g
Mid Afternoon Meal
• Low sodium saltine crackers (5)
• Swiss cheese (1 ounce)
• 100% grape juice (4 ounces)
Meal total: 247 calories
• Protein: 9 g
• Sodium: 89 mg
• Carbohydrate: 32 g
Dinner
• Baked cod fish (3 ounces)
• Cooked brown rice (1/2 cup)
• Unsalted butter (1 teaspoon)
• Cooked asparagus (5) with 2 teaspoons
olive oil
Meal total: 312 calories
• Protein: 22 g
• Sodium: 344 mg
• Carbohydrate: 26 g
Later Evening Meal
• Angel food cake (1 slice)
• Fresh strawberries (2)
• Raw almond slices (2 Tablespoons)
• Cool-whip (2 Tablespoons)
Meal total: 291 calories
• Protein: 7 g
• Sodium: 294 mg
• Carbohydrate: 42 g
Total Daily Nutrition:
1800 calories, 85 g protein, 1500 mg sodium, 220 g carbohydrates
(Individual needs may vary)
Appendix 4: Food Sources of Protein
3 ounce serving of cooked meat or fish is about the size of a deck of cards.
Food
Meat
• Pork, Chicken, Turkey, Beef
Fish
• Salmon, Halibut, Tuna
• Shrimp
Eggs
• Egg
• Egg Whites/Egg Beaters®
Dairy
• Milk • Kefir
• Cheese
• Cottage Cheese
• Yogurt
• Greek Yogurt
Dried Beans/Legumes
• Black, Lentil, Kidney • Hummus
Nuts
• Almonds, Walnuts
• Peanut Butter
Other Protein
• Tofu
• Soy Milk
• Edamame
• Tempeh
• Seitan
Serving Size
Grams of Protein
3 ounces (cooked)
21 grams
3 ounces (cooked)
3 ounces 21 grams
21 grams
1 large (cooked)
3 tablespoons (cooked)
7 grams
5 grams
1 cup
1 cup 1 Ounce Slice
½ cup
¾ cup
¾ cup
8 grams
8 grams
7 grams
14 grams
11 grams
19 grams
½ cup (cooked)
1/3 cup (cooked)
7 grams
4 grams
½ cup
2 tablespoons
7 grams
7 grams
4 ounces
1 cup
4 ounces
4 ounces
4 ounces
8 grams
7 grams
11 grams
20 grams
31 grams
Appendix 5: Sample Snack Recipes
Blueberry Peach Smoothie*
(1 serving)
No-Cook Oatmeal
(1 serving)
INGREDIENTS
½ cup frozen blueberries
½ cup frozen peach slices
½ cup plain Greek yogurt
1 tablespoon honey
1 cup milk
INGREDIENTS
½ cup dry rolled oats
½ cup plain Greek yogurt
½ cup milk
1 tablespoon honey
2 tablespoons chopped nuts
½ cup fresh or frozen berries
DIRECTIONS
Add all ingredients to a blender.
Process until the mixture is completely
smooth.
If the smoothie is too thick, add additional
milk.
NUTRITION FACTS
370 calories
22 grams protein
165 milligrams sodium
55 grams carbohydrates
* Requires a blender to prepare
DIRECTIONS
In a bowl, mix oats, yogurt, milk and
honey together. Cover with plastic wrap
and refrigerate at least 6 hours. When
ready to serve, stir in chopped nuts,
berries and cinnamon.
NUTRITION FACTS
475 calories
24 grams protein
120 milligrams sodium
62 grams carbohydrates