Comparative Analysis of Nutrition Interventions in Organ Transplant Patients across Diverse Healthcare Settings: A Survey-based Study

INTRODUCTION: In the past decade, India has witnessed an exponential increase in the number of solid organ transplants which has highlighted critical challenges related to immunological compatibility, nutritional recovery and graft longevity. Optimal nutrition plays a critical role in solid organ transplants as it enhances immune function, facilitates recovery and improves graft survival and patient outcomes. Addressing malnutrition during the pre-transplant phase is essential for optimizing the post-transplant outcomes. However, despite its recognized importance, nutritional care practices vary widely across healthcare settings. Nutritional Assessment differs based on the specific organ transplanted and the healthcare setup, with a lack of standardized approaches in managing nutritional care for solid organ transplant recipients. This study aims to evaluate current practices and assess the integration of evidence-based guidelines into routine transplant nutrition care. OBJECTIVES: To observe nutritional care practices for treating solid organ transplant recipients across India based evidence-based protocols. The long-term aim of IAPEN India Nutrition in Transplant Core Group is focused on developing Indian Practice Nutrition Recommendations. MATERIALS AND METHODS: A structured survey was disseminated via Online Forms to healthcare professionals involved in solid organ transplants, including dietitians, physicians, nurses, transplant coordinators and intensivists. The survey covered questions based on Nutrition assessment methods in pre-transplant optimization, planning of nutritional interventions in the pre-transplant as well as post-transplant phase and the dietary practices and recommendations followed. Responses were analyzed to identify trends and opportunities for standardization. RESULTS: A total (N=56) of 82.1% of respondents were dietitians involved in solid organ transplant, with 66.7% participating in Multidisciplinary Teams (MDTs). About 41% of centers conducted all transplant types, while 16% specialized in Renal or Bone Marrow Transplants (BMT). For heart and lung transplants, 52% of centers conducted pre-transplant evaluations a month before surgery. Nearly half of the respondents used Nutrition Risk Screening 2002 along with other tools for nutrition assessment while 26.8% used Subjective Global Assessment as the sole tool for assessment. Serum albumin was widely used for biochemical assessment, and 20% provided comprehensive pre-workups for 60–75% of patients. Extracorporeal Membrane Oxygenation (ECMO) support was provided universally in 5% of centers, with 33.3% using it for 3–5 days. For liver transplants, 60% of centers restricted table salt intake (Sodium Chloride) to 2–3 grams/day, with most employing structured nutritional assessments. Neutropenic diets were universally implemented in 33.3% of centers, while 25% limited their use to renal or BMT patients. Less than 50% practiced UV sterilization of meals. Dietary protocols included high-protein diets (29%) and fluid restrictions (41% limited to 1000–1500 mL/day). Renal transplant protocols emphasized neutropenic diets for 3–6 months (39.3%) and protein intakes of 1.0–1.2 g/kg/day (33%). BMT interventions often involved gut-friendly diets (37.5%) and high-protein strategies (26.8%). DISCUSSIONS/CONCLUSIONS: This study reveals significant variability in nutritional interventions for transplant patients across India. While MDTs and tailored interventions are common, inconsistencies in practice point to a lack of standardized protocols. The findings emphasize the urgent need for evidence-based Indian Practice Nutrition Recommendations to address gaps, streamline pre-transplant optimization and post-transplant nutritional care, and optimize clinical outcomes across diverse healthcare settings.