Nutrition. Patient Education. For a liver transplant

Transcription

1 Patient Education Nutrition For a liver transplant After transplant, good nutrition will help you heal, fight infection and achieve your desired weight. What you eat can also help reduce some of the side effects of the medications you must take after the transplant. The transplant dietitians will help you learn what you need to know about good nutrition both before and after your transplant surgery.

2 Nutrition Page 6-2 Good nutrition is important both before and after your liver transplant. Before transplant, following the dietary guidelines given by your dietitian will help you to be in the best health possible. Nutrition After Transplantation Right after the transplant, you will not be able to eat or drink for several days. During this time you may receive intravenous (IV) nutrition or tue feeding. This will continue until you are eating well. The dietitian will monitor your intake and will begin teaching you about the posttransplant diet including tips to help you choose the right food from the hospital menu. Getting Started Your medicines may cause side effects. Some of the medication effects and how you can help control them are listed in the chart on page 6-3. You will meet with a dietitian both before and after your transplant to determine your own nutritional needs.

3 Page 6-3 Nutrition Side Effects Medicines Nutrition Intervention Fluid retention Prednisone Limit sodium; do not add salt Sirolimus to foods; do not eat salty (Rapamune) foods High blood Cyclosporine Same as above pressure Tacrolimus (FK-506) Increased Prednisone Choose lowfat/low-calorie appetite foods Exercise Loss of muscle Prednisone Eat high-protein foods mass Exercise High blood Prednisone Control carbohydrate intake sugar Cyclosporine Control portion sizes Tacrolimus Exercise Sirolimus Low absorption Prednisone Include 3 servings from the of calcium, Sirolimus dairy group each day or take phosphorus calcium supplements High blood Prednisone Choose lowfat/lowcholesterol levels Cyclosporine cholesterol foods Tacrolimus High potassium Cyclosporine Limit high-potassium foods Tacrolimus Sirolimus High blood Cyclosporine Avoid grapefruit and medication levels Tacrolimus grapefruit juice Sirolimus

4 Nutrition Page 6-4 You have probably already made changes in your eating habits. You might need to make further changes based on how your medications affect you. If this happens, your dietitian will work with you to tailor the diet to meet your needs. The Post-Transplant Diet As your discharge date draws near, your dietitian will instruct you on a proper post-transplant diet. Protein You will need to follow a high-protein diet to help with wound healing. If you are taking prednisone, you are also at risk for losing muscle mass. A highprotein diet will help limit this muscle loss. Your protein needs will be high for the first 6 weeks after transplant. After you have fully healed, and the prednisone dose decreases, your protein needs decrease. Your dietitian will instruct you as your needs change. It is very critical that you strive to meet your protein needs every day. During the first few weeks after transplant, you should not be concerned about your weight. It will be difficult to determine your actual weight due to fluid shifts. The most important goal at this point is for you to consume enough calories and protein to support wound healing and to build muscle tissue. You will be asked to keep a daily food record for a while. This is helpful when you meet with the clinic dietitian.

5 Page 6-5 Nutrition Protein Sources This list contains foods that are rich in high-quality protein. Each food listed in the portion size given is equal to 1 protein serving or 7 grams of protein. Your dietitian will help you determine how many servings of protein you will need each day. 1 oz. of any cooked fish, poultry or lean meat 1 oz. cheese 1 egg or 1 /4 cup egg substitute 1 cup of 2%, 1% or skim milk 1 cup lowfat yogurt 1 /4 cup lowfat cottage cheese 1 /4 cup canned tuna or salmon 2 tablespoons peanut butter 1 cup pudding 3 /4 cup custard 3 oz. tofu 3 /4 cup ice milk 6 medium oysters 2 oz. shrimp, clams, lobster, scallops, or crab 1 cup cooked peas or beans

6 Nutrition Page 6-6 This list contains examples of protein foods. You can use this list to help estimate your protein intake. A portion of meat the size of a deck of cards equals 3 ounces or 3 protein servings. Average hamburger patty = 3 oz. 3 x 4 steak = 4 oz. Average pork chop = 3 oz. 1 /2 small chicken breast = 4 oz. Chicken drumstick = 1 1 /2 oz. Chicken thigh = 2 oz. 3 x 3 fish fillet = 3 oz. 1 cup canned pork and beans = 2 protein servings 1 cup canned chili = 2 protein servings 1 cup canned soup prepared with milk = 1 protein serving 1 cup canned soup prepared with water = 1 /2 protein serving Sodium Intake You will also need to limit the amount of sodium in your diet after transplantation. The sodium restriction should be about 2000 to 3000 milligrams (mg) daily. How strict you need to be will depend on your symptoms. If you are retaining fluids and your blood pressure is high, then you will need to be stricter. If these are not concerns for you, then you can be more liberal with your sodium intake. Your

7 Page 6-7 Nutrition dietitian will help you determine how strict you need to be with your sodium intake. Potassium Intake A potassium-restricted diet may be needed after your transplant. Cyclosporine and tacrolimus (FK-5O6) might cause your blood potassium to increase above normal levels. If this occurs, you will need to limit the potassium in your diet. Your dietitian will follow your blood potassium values and will let you know if you need to restrict potassium. Fat and Cholesterol Intake Follow a low-fat, low-cholesterol diet at home. The immunosuppressive medications cyclosporine, tacrolimus, prednisone and sirolimus may contribute to elevated blood cholesterol and triglyceride levels, which increases your risk of heart disease. A low-fat, lowcholesterol diet may reduce this risk and will also help you avoid unwanted weight gain. Triglycerides Triglycerides are one of two major fats carried in the blood. Triglycerides are in the food we eat and they are formed by the liver from extra protein, starch, and

8 Nutrition Page 6-8 sugar. They provide energy to our muscles, but if not used, they are stored as body fat. Desirable levels are less than 150 mg per deciliter of blood. If your level is too high, your doctor may ask you to exercise to lose weight. Cholesterol Cholesterol is the second most important blood fat. It s used as building blocks for cells and hormones. The liver makes all we need, yet we get much more from the animal products in our diet. Lowfat, Low-cholesterol Ideas Below are several tips that can help you lower the total fat and cholesterol in your diet after you leave the hospital. Your dietitian can also help you figure out what to eat or limit. Chill all homemade soups and stews before serving to lift off hardened fat, then reheat. Use only water-packed canned fish, such as tuna, instead of those packed in oil. Remove all visible fats from meats, and skins from poultry. Bake, broil, roast or barbeque instead of frying.

9 Page 6-9 Nutrition Use lowfat milk and milk products such as lowfat yogurt and cottage cheese. Use vinegar, lemon, herbs and spices to flavor meats. Substitute them for sauces, gravies, butter, margarine and oils. Substitute fish or poultry for red meats to lower your cholesterol and fat intake. Include good sources of omega-3 fats daily. Some examples are salmon, tuna, and flax seed. Avoid fatty, deep-fried foods. Breading acts as a sponge to absorb the fat used in cooking. Foods fried at lower temperatures absorb more fat. Use oils or margarine sparingly. Choose margarines without trans fat. This will be indicated on the label. Eat higher fiber foods such as whole grains, fresh fruits and vegetables to help reduce the absorption of cholesterol. Fast foods contain up to 50% of their calories as fat, as well as loads of sodium. Make wise choices when eating out, or carry your own lunch and snacks so you are sure of their nutrient content.

10 Nutrition Page 6-10 Processed meats such as hot dogs, sausages, bacon, and lunch meats are high in fat and cholesterol. Instead, choose lean meats such as top round, top sirloin, pork tenderloin, or Canadian bacon. Weight Maintenance After Transplantation You may be concerned about weight loss or weight gain after transplantation. Whatever your concerns are, keep these key points in mind. If it is weight loss you desire: You must still eat the protein and calories that are prescribed for you for about the first 2 months to promote wound healing and rebuild muscle. After that time, you can begin to work with the outpatient dietitian on an exercise and weight-loss program. It will still be important to eat the correct amount of protein since you want to lose fat, not muscle. Follow a diet that is best for your overall good health, allowing for weight loss of no more than 2 pounds a week.

11 Page 6-11 Nutrition If you are taking prednisone, remember that it does not cause you to gain weight. It can, however, increase your appetite, causing you to eat more. You have the power to maintain your weight by choosing healthy foods (especially at snack time) that are nutritious and low in calories. Regular activity will help you burn calories and build muscle. Even the simplest activity, like daily walking, will help a great deal. Check with your doctor about guidelines for exercising after your transplant. Right after transplant, you will be coming in to the clinic on a regular basis. Many patients eat in the medical center cafeteria on these days. Although the cafeteria has a wide variety of foods, it is okay to bring a healthy sack breakfast or lunch to help you avoid making unhealthy food choices. If it is weight gain you desire: Many patients are poorly nourished or below their ideal weight before transplant, and actually need to gain weight after surgery. We recommend a gradual weight gain of 1 /2 to 1 pound a week to ensure that you are gaining muscle mass, not just fat weight.

12 Nutrition Page 6-12 Your dietitian will describe ways in which you can increase your calories while following the recommended guidelines. Before you leave the hospital, your dietitian will go over all the above information with you (and other nutritional concerns that you might have). Use the food lists, cooking ideas, and tables in this section of your manual and in the Nutrition Education material that will help you with these recommendations. The outpatient dietitian can meet with you during clinic visits to discuss any questions and/or concerns you may have. Just as before your surgery, what you eat plays a key role in good health after transplant. Food Safety Tips Food safety is important to help prevent infections. Keep these tips in mind: Your refrigerator temperature should be just below 40º Fahrenheit. Your freezer should be kept at 0º Fahrenheit. Refrigerate leftovers promptly, within 2 hours of preparation.

13 Page 6-13 Nutrition Transfer food from hot pans to containers before refrigeration. Use shallow containers to help food cool quickly. Guidelines for the refrigeration of raw meats are: - Do not keep raw fish for more than 24 hours. - Raw poultry should be thrown out after 2 or 3 days. - Red meat can be kept safely for 3 to 4 days. Throw out leftovers after 3 or 4 days. Lunch meats in vacuum-sealed packages can be kept for 2 or 3 weeks, but should be eaten within 5 to 7 days once the package has been opened. Throw out cans that have bulges, dents, holes, ruts, or leaks. Wipe off cans before opening them. Clean your can opener often. Use hot water and dish soap or clean it in the dishwasher. Don t smell foods to check for freshness. If a food is moldy, throw it out and clean the area where it was stored.

14 Nutrition Page 6-14 Don t cook whole stuffed poultry in the microwave. When defrosting food in the microwave, finish cooking it right away. Do not use the same spoon for raw and cooked foods. Don t taste raw or partially cooked meats, poultry, eggs, fish, or shellfish. This includes cake batter or cookie dough that contains eggs. Marinate and defrost foods in the refrigerator, not at room temperature. Wash hands well before preparing food for eating. Put cooked or grilled meat, fish, or chicken on a clean plate when it is done. Keep cold foods refrigerated or on ice. When reheating soups, broths, and stews, boil for several minutes to kill off any bacteria. Do not taste food that looks suspicious or smells bad. Dispose of dishes, pots, and pans that are cracked. They are too hard to clean well.

15 Page 6-15 Nutrition Do not eat foods that have cooled or warmed to room temperature. This includes picnic or smorgasbord foods such as meats, fish, poultry, potato or pasta salad. Do not eat raw eggs, meat, fish, or poultry. Cook meat to well done. House dressings in restaurants may contain raw eggs. Bottled dressings are okay. Do not eat raw peas, raw bean sprouts, or raw alfalfa sprouts. If they are cooked, they are okay to eat. Because of a risk of listeria related to packaging, heat lunch meats and deli meats before eating them. Do not eat soft cheeses such as feta, Brie, Camembert, blue-veined cheeses, and Mexican-style cheeses. Other hard cheeses that have been pasteurized are okay to eat.

16 Nutrition Page 6-16 Questions? Your questions are important. Call your transplant coordinator during business hours. Liver Care and Transplantation Notes Liver Care and Transplantation Box N.E. Pacific St., Seattle, WA University of Washington Medical Center 06/2003 Rev. 05/2005 Reprints: UH1914