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Transplant is a gift of life – donated generously by an individual, and received anonymously by another. Transplants treat, and sometimes even cure, disabling life-ending diseases, such as kidney, liver and heart failure, blood and immune disorders, as well as permanent blindness.

Before a transplant, it is essential for the recipients to maintain optimal health status, said Ms Tan Sheau Kang, Dietitian, Department of Dietetics, Singapore General Hospital (SGH), a member of the SingHealth group. Any malnourishment, underweight or obese may run the risk of infections and difficulty in surgical wound healing after transplant. Obese patients may be at higher risks of developing heart disease and diabetes.

Below are the dietary needs at different stages of the transplant.

Preparing for transplant – special diet needs

  • One of the first things that dietitians do for patients at this stage is to accurately assess their nutritional status using various tools, such as the body mass index, dietary recall, blood test results, the Subjective Global Assessment (SGA), and the dynamometer. The SGA tracks changes in weight and diet, gastrointestinal symptoms, functional capacity and metabolic demand. The dynamometer measures muscle strength.
  • Advanced liver disease patients tend to suffer from ascites, or fluid retention in the abdomen, so they may look overweight. In reality, they may be malnourished so they usually need a higher energy and protein diet.
  • Kidney failure patients are likely to have undergone a long period of dialysis. They would have been put on a restricted diet to maintain the levels of electrolytes and fluids in the body, and are likely to have poor appetite.
  • Renal patients on dialysis need a high-protein diet to replenish the protein lost during dialysis, while non-dialysis patients may need an adjustment in their diet to minimise protein waste build-up in the blood.

Eat well for recovery

  • Post-surgery patients need to eat well after surgery to boost their recovery. Dietitians usually prescribe a high-protein and high calorie meal to boost their nutritional status, and to aid recovery.
  • Post-surgery patients will be on several immunosuppressant drugs, and they will have a lower immune system than the general population. Dietitians will educate the patients on the practice of good food hygiene to minimise the incidence of food-borne illnesses.
  • During this period of about three months, the patient's diet is monitored very closely as he is in hospital immediately post-transplant, and after discharge, he will be returning to see the transplant team every week or fortnightly.

Cultivate healthy eating habits

  • When the transplant patient's condition is stable, he is reviewed less frequently. As with other aspects of long-term care, he will learn about healthy eating habits and a healthy lifestyle to prevent and manage nutrition-related side effects from immunosuppressant drugs. Immunosuppressant drugs increase the risk of conditions such as weight gain, diabetes, high blood cholesterol and high blood pressure.
  • Life-size food models or replicas are used as teaching tools by dietitians to show and explain the portion of each food group the patients require to meet their individual daily nutritional needs. Food photos of different food court dishes such as a bowl of noodle soup or a serving of roti prata are also used for more effective nutrition education.
  • These tools help to illustrate the amount of sodium each dish typically has. In this way, patients have a better sense of the amount of sodium that they will be consuming. For example, a single bowl of fish ball noodle soup contains the equivalent of one teaspoon of salt (or approximately 2,000mg sodium), which is more than the recommended amount of sodium for a day.

Ref. Q15