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Karaciğer Transplantasyonunda Beslenme Durumu ve İmmünonütrisyonun Etkisi

Year 2025, Volume: 10 Issue: 1, 135 - 142, 31.01.2025
https://doi.org/10.61399/ikcusbfd.1424597

Abstract

Karaciğer nakli yapılan hastalarda, son dönem karaciğer yetmezliği nedeniyle karbonhidrat, lipit ve protein metabolizmasında çeşitli anormallikler ortaya çıkar. Bu durum, klinik durumda bozulmaya ve malnütrisyona yol açar. Malnütrisyon, karaciğer nakli yapılan hastaların birçoğunda mevcuttur ve artan morbidite ve mortalite ile ilişkilidir. Bu hastalarda beslenme durumunun değerlendirilmesi, beslenme eksikliklerinin belirlenmesi ve düzeltilmesi için son derece önemlidir. Beslenme danışmanlığı ile gerektiğinde müdahale sağlanarak bu bozukluklar önlenebilir. Bu bağlamda diyetisyen, çeşitli beslenme sorunlarının çözümü için uygun beslenme tedavisi sağlayarak nakil ekibinin bir parçası olarak tamamlayıcı bir rol oynar. Naklin tüm aşamalarında yeterli beslenme desteği sağlanmalıdır. Beslenme tedavisi nakil öncesi, nakil esnası ve nakil sonrası dönemde devam etmelidir. Yetersiz beslenen hastalar için, nakil öncesi ve sonrası dönemde sağlanan immünonütrisyon, beslenme durumunun iyileşmesinde faydalı olmaktadır. Bu derleme kapsamında, karaciğer nakli yapılan hastalarda nakil öncesi ve sonrasında beslenme durumunun değerlendirilmesi adına kullanılan yöntemleri, nakil öncesi ve sonrası beslenme önerilerini ve tedavileri gözden geçirmek amaçlanmıştır.

References

  • Bezinover D, Saner F. Organ transplantation in the modern era. Springer; 2019. p. 1-4.
  • Vanholder R, Domínguez-Gil B, Busic M, Cortez-Pinto H, Craig JC, Jager KJ, et al. Organ donation and transplantation: a multi-stakeholder call to action. Nature Reviews Nephrology. 2021;17(8):554-68.
  • Black CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21st century. Annals of translational medicine. 2018;6(20).
  • Moray G, Arslan G, Haberal M. The history of liver transplantation in Turkey. Exp Clin Transplant. 2014;12(suppl 1):20-3.
  • Jamioł-Milc D, Gudan A, Kaźmierczak-Siedlecka K, Hołowko-Ziółek J, Maciejewska-Markiewicz D, Janda-Milczarek K, et al. Nutritional Support for Liver Diseases. Nutrients. 2023;15(16):3640.
  • Agarwal J, Saju A, Ravindran GC, Sudhindran S. Effect of Perioperative Immunonutrition Supplementation in Patients Undergoing Living Donor Liver Transplantation. Kerala Surgical Journal. 2021;27(1):37-42.
  • Lei Q, Wang X, Zheng H, Bi J, Tan S, Li N. Peri-operative immunonutrition in patients undergoing liver transplantation: a meta-analysis of randomized controlled trials. Asia Pacific journal of clinical nutrition. 2015;24(4):583-90.
  • Hammad A, Kaido T, Aliyev V, Mandato C, Uemoto S. Nutritional therapy in liver transplantation. Nutrients. 2017;9(10):1126.
  • Anastacio LR, Correia MITD. Nutrition therapy: Integral part of liver transplant care. World journal of gastroenterology. 2016;22(4):1513.
  • Zhang Q-K, Wang M-L. The management of perioperative nutrition in patients with end stage liver disease undergoing liver transplantation. Hepatobiliary surgery and nutrition. 2015;4(5):336.
  • Kaido T, Mori A, Ogura Y, Ogawa K, Hata K, Yoshizawa A, et al. Pre-and perioperative factors affecting infection after living donor liver transplantation. Nutrition. 2012;28(11-12):1104-8.
  • Seo KW, Seo KI, Ha HM, Lee JY, Choi YI, Moon HH, et al. Poor preoperative enteral nutrition would be a risk factor for readmission due to infection after liver transplantation. Korean Journal of Transplantation. 2020;34(1):38-46.
  • Yirui L, Yin W, Juan L, Yanpei C. The clinical effect of early enteral nutrition in liver-transplanted patients: a systematic review and meta-analysis. Clinics and Research in Hepatology and Gastroenterology. 2021;45(3):101594.
  • Plank LD, McCall JL, Gane EJ, Rafique M, Gillanders LK, McIlroy K, et al. Pre-and postoperative immunonutrition in patients undergoing liver transplantation: a pilot study of safety and efficacy. Clinical nutrition. 2005;24(2):288-96.
  • Lim H-S, Kim H-C, Park Y-H, Kim S-K. Evaluation of malnutrition risk after liver transplantation using the nutritional screening tools. Clinical nutrition research. 2015;4(4):242-9.
  • Pottakkat B. Effect Of Immuno-Nutrition On Nutritional Status Of Liver Transplant Waiting Patients–Randomized Controlled Trial. Int J Acad Med Pharm. 2023;5(2):1215-20.
  • Bischoff SC, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN practical guideline: Clinical nutrition in liver disease. Clinical nutrition. 2020;39(12):3533-62.
  • Kornberg A, Kaschny L, Kornberg J, Friess H. Preoperative prognostic nutritional index may be a strong predictor of hepatocellular carcinoma recurrence following liver transplantation. Journal of Hepatocellular Carcinoma. 2022:649-60.
  • Tsao Y-T, Lee W-C, Huang C-H, Lin I-H, Huang Y-Y. A comprehensive investigation of nutritional status and psoas muscle mass in predicting five-year survival in patients with liver transplant. Journal of the Formosan Medical Association. 2022;121(7):1317-24.
  • Peng J-K, Hepgul N, Higginson IJ, Gao W. Symptom prevalence and quality of life of patients with end-stage liver disease: a systematic review and meta-analysis. Palliative medicine. 2019;33(1):24-36.
  • Urano E, Yamanaka‐Okumura H, Teramoto A, Sugihara K, Morine Y, Imura S, et al. Pre‐and postoperative nutritional assessment and health‐related quality of life in recipients of living donor liver transplantation. Hepatology Research. 2014;44(11):1102-9.
  • Wong CS, Praseedom R, Liau S-S. Perioperative immunonutrition in hepatectomy: A systematic review and meta-analysis. Annals of Hepato-biliary-pancreatic Surgery. 2020;24(4):396-414.
  • Brustia R, Monsel A, Skurzak S, Schiffer E, Carrier FM, Patrono D, et al. Guidelines for perioperative care for liver transplantation: enhanced recovery after surgery (ERAS) recommendations. Transplantation. 2022;106(3):552-61.
  • Ribeiro HS, Coury NC, de Vasconcelos Generoso S, Lima AS, Correia MITD. Energy balance and nutrition status: a prospective assessment of patients undergoing liver transplantation. Nutrition in Clinical Practice. 2020;35(1):126-32.
  • Ramachandran G, Pottakkat B. Nutritional therapy to cirrhotic patients on transplantation waiting lists. Journal of Liver Transplantation. 2022;5:100060.
  • Sanchez AJ, Aranda‐Michel J. Nutrition for the liver transplant patient. Liver transplantation. 2006;12(9):1310-6.
  • Hsu Y-M, Kuan H-C, Chen Y-A, Chiu C-W, Chen P-C, Tam K-W. Effects of Branched-Chain Amino Acids on Patients Undergoing Hepatic Intervention: A Meta-Analysis of Randomized Controlled Trials. 2022.
  • Trigui A, Rose CF, Bémeur C. Nutritional Strategies to Manage Malnutrition and Sarcopenia following Liver Transplantation: A Narrative Review. Nutrients. 2023;15(4):903.
  • Lattanzi B, Giusto M, Albanese C, Mennini G, D’Ambrosio D, Farcomeni A, et al. The effect of 12 weeks of β-hydroxy-β-methyl-butyrate supplementation after liver transplantation: a pilot randomized controlled study. Nutrients. 2019;11(9):2259.
  • Trovato F, Artru F. Nutritional optimization in liver transplant patients: from the pre-transplant setting to post-transplant outcome. Acta Gastro Enterologica Belgica. 2023;86:335-42.
  • Richardson RA, Garden OJ, Davidson HI. Reduction in energy expenditure after liver transplantation. Nutrition. 2001;17(7-8):585-9.
  • Egashira K, Sasaki H, Higuchi S, Ieiri I. Food-drug interaction of tacrolimus with pomelo, ginger, and turmeric juice in rats. Drug metabolism and pharmacokinetics. 2012;27(2):242-7.
  • Zhang C, Chen B, Jiao A, Li F, Wang B, Sun N, et al. The benefit of immunonutrition in patients undergoing hepatectomy: a systematic review and meta-analysis. Oncotarget. 2017;8(49):86843.
  • Plank LD, Mathur S, Gane EJ, Peng SL, Gillanders LK, McIlroy K, et al. Perioperative immunonutrition in patients undergoing liver transplantation: a randomized double‐blind trial. Hepatology. 2015;61(2):639-47.
  • Qiu Y, Zhu X, Wang W, Xu Q, Ding Y, editors. Nutrition support with glutamine dipeptide in patients undergoing liver transplantation. Transplantation proceedings; 2009: Elsevier.
  • Kamo N, Kaido T, Hamaguchi Y, Uozumi R, Okumura S, Kobayashi A, et al. Impact of enteral nutrition with an immunomodulating diet enriched with hydrolyzed whey peptide on infection after liver transplantation. World Journal of Surgery. 2018;42:3715-25.
  • Kaido T, Ogura Y, Ogawa K, Hata K, Yoshizawa A, Yagi S, et al. Effects of post-transplant enteral nutrition with an immunomodulating diet containing hydrolyzed whey peptide after liver transplantation. World journal of surgery. 2012;36:1666-71.
  • Zhu X, Wu Y, Qiu Y, Jiang C, Ding Y. Effects of ω‐3 fish oil lipid emulsion combined with parenteral nutrition on patients undergoing liver transplantation. Journal of Parenteral and Enteral Nutrition. 2013;37(1):68-74.
  • Ibrahim ES, Saleh SM, Mohamed E, Ahmed E. Effect of omega-3 on hepatic regeneration in adult living donors undergoing hepatic resections for liver transplantation: A randomized controlled trial. Journal of Critical Care. 2016;31(1):157-62.
  • Gao B, Luo J, Liu Y, Zhong F, Yang X, Gan Y, et al. Clinical efficacy of perioperative immunonutrition containing omega-3-fatty acids in patients undergoing hepatectomy: A systematic review and meta-analysis of randomized controlled trials. Annals of Nutrition and Metabolism. 2021;76(6):375-86.
  • Russell K, Zhang H-G, Gillanders LK, Bartlett AS, Fisk HL, Calder PC, et al. Preoperative immunonutrition in patients undergoing liver resection: a prospective randomized trial. World Journal of Hepatology. 2019;11(3):305.
  • Beevi SS S, Pottakkat B (March 30, 2023) Effect of Immunonutrition on the Liver Function Status of End-Stage Liver Disease Patients Waiting/Referred for Liver Transplant: A Randomized Controlled Trial. Cureus 15(3): e36923. DOI 10.7759/cureus.36923.
  • Assimakopoulos SF, Bhagani S, Aggeletopoulou I, Tsounis EP, Tsochatzis EA. The role of gut barrier dysfunction in postoperative complications in liver transplantation: Pathophysiological and therapeutic considerations. Infection. 2024:1-14.
  • Ma M, Wang X, Li J, Jiang W. Efficacy and safety of probiotics and prebiotics in liver transplantation: A systematic review and meta‐analysis. Nutrition in Clinical Practice. 2021;36(4):808-19.
  • Xu X, Zhang C, Tang G, Wang N, Feng Y. Updated Insights into Probiotics and Hepatobiliary Diseases. Biomedicines. 2024;12(3):515.
  • Grąt M, Wronka KM, Lewandowski Z, Grąt K, Krasnodębski M, Stypułkowski J, et al. Effects of continuous use of probiotics before liver transplantation: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition. 2017;36(6):1530-9.

Nutritional Status and the Impact of Immunonutrition in Liver Transplantation

Year 2025, Volume: 10 Issue: 1, 135 - 142, 31.01.2025
https://doi.org/10.61399/ikcusbfd.1424597

Abstract

In patients undergoing liver transplantation, various abnormalities in carbohydrate, lipid, and protein metabolism arise due to end-stage liver failure. These conditions lead to clinical deterioration and malnutrition. Malnutrition is present in many liver transplant patients and is associated with increased morbidity and mortality. Evaluating nutritional status and identifying and correcting nutritional deficiencies is extremely important for these patients. Nutritional counseling and necessary interventions can prevent these disorders. In this context, dietitians play a complementary role as part of the transplant team by providing appropriate nutritional therapy to address various nutritional issues. Adequate nutritional support should be provided at all stages of the transplant process. Nutritional therapy should continue in the pre-transplant, peri-transplant, and post-transplant periods. Immunonutrition provided before and after transplantation is beneficial for improving the nutritional status of malnourished patients. This review aims to examine the methods used to evaluate nutritional status before and after liver transplantation, as well as pre- and post-transplant nutritional recommendations and therapies.

References

  • Bezinover D, Saner F. Organ transplantation in the modern era. Springer; 2019. p. 1-4.
  • Vanholder R, Domínguez-Gil B, Busic M, Cortez-Pinto H, Craig JC, Jager KJ, et al. Organ donation and transplantation: a multi-stakeholder call to action. Nature Reviews Nephrology. 2021;17(8):554-68.
  • Black CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21st century. Annals of translational medicine. 2018;6(20).
  • Moray G, Arslan G, Haberal M. The history of liver transplantation in Turkey. Exp Clin Transplant. 2014;12(suppl 1):20-3.
  • Jamioł-Milc D, Gudan A, Kaźmierczak-Siedlecka K, Hołowko-Ziółek J, Maciejewska-Markiewicz D, Janda-Milczarek K, et al. Nutritional Support for Liver Diseases. Nutrients. 2023;15(16):3640.
  • Agarwal J, Saju A, Ravindran GC, Sudhindran S. Effect of Perioperative Immunonutrition Supplementation in Patients Undergoing Living Donor Liver Transplantation. Kerala Surgical Journal. 2021;27(1):37-42.
  • Lei Q, Wang X, Zheng H, Bi J, Tan S, Li N. Peri-operative immunonutrition in patients undergoing liver transplantation: a meta-analysis of randomized controlled trials. Asia Pacific journal of clinical nutrition. 2015;24(4):583-90.
  • Hammad A, Kaido T, Aliyev V, Mandato C, Uemoto S. Nutritional therapy in liver transplantation. Nutrients. 2017;9(10):1126.
  • Anastacio LR, Correia MITD. Nutrition therapy: Integral part of liver transplant care. World journal of gastroenterology. 2016;22(4):1513.
  • Zhang Q-K, Wang M-L. The management of perioperative nutrition in patients with end stage liver disease undergoing liver transplantation. Hepatobiliary surgery and nutrition. 2015;4(5):336.
  • Kaido T, Mori A, Ogura Y, Ogawa K, Hata K, Yoshizawa A, et al. Pre-and perioperative factors affecting infection after living donor liver transplantation. Nutrition. 2012;28(11-12):1104-8.
  • Seo KW, Seo KI, Ha HM, Lee JY, Choi YI, Moon HH, et al. Poor preoperative enteral nutrition would be a risk factor for readmission due to infection after liver transplantation. Korean Journal of Transplantation. 2020;34(1):38-46.
  • Yirui L, Yin W, Juan L, Yanpei C. The clinical effect of early enteral nutrition in liver-transplanted patients: a systematic review and meta-analysis. Clinics and Research in Hepatology and Gastroenterology. 2021;45(3):101594.
  • Plank LD, McCall JL, Gane EJ, Rafique M, Gillanders LK, McIlroy K, et al. Pre-and postoperative immunonutrition in patients undergoing liver transplantation: a pilot study of safety and efficacy. Clinical nutrition. 2005;24(2):288-96.
  • Lim H-S, Kim H-C, Park Y-H, Kim S-K. Evaluation of malnutrition risk after liver transplantation using the nutritional screening tools. Clinical nutrition research. 2015;4(4):242-9.
  • Pottakkat B. Effect Of Immuno-Nutrition On Nutritional Status Of Liver Transplant Waiting Patients–Randomized Controlled Trial. Int J Acad Med Pharm. 2023;5(2):1215-20.
  • Bischoff SC, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN practical guideline: Clinical nutrition in liver disease. Clinical nutrition. 2020;39(12):3533-62.
  • Kornberg A, Kaschny L, Kornberg J, Friess H. Preoperative prognostic nutritional index may be a strong predictor of hepatocellular carcinoma recurrence following liver transplantation. Journal of Hepatocellular Carcinoma. 2022:649-60.
  • Tsao Y-T, Lee W-C, Huang C-H, Lin I-H, Huang Y-Y. A comprehensive investigation of nutritional status and psoas muscle mass in predicting five-year survival in patients with liver transplant. Journal of the Formosan Medical Association. 2022;121(7):1317-24.
  • Peng J-K, Hepgul N, Higginson IJ, Gao W. Symptom prevalence and quality of life of patients with end-stage liver disease: a systematic review and meta-analysis. Palliative medicine. 2019;33(1):24-36.
  • Urano E, Yamanaka‐Okumura H, Teramoto A, Sugihara K, Morine Y, Imura S, et al. Pre‐and postoperative nutritional assessment and health‐related quality of life in recipients of living donor liver transplantation. Hepatology Research. 2014;44(11):1102-9.
  • Wong CS, Praseedom R, Liau S-S. Perioperative immunonutrition in hepatectomy: A systematic review and meta-analysis. Annals of Hepato-biliary-pancreatic Surgery. 2020;24(4):396-414.
  • Brustia R, Monsel A, Skurzak S, Schiffer E, Carrier FM, Patrono D, et al. Guidelines for perioperative care for liver transplantation: enhanced recovery after surgery (ERAS) recommendations. Transplantation. 2022;106(3):552-61.
  • Ribeiro HS, Coury NC, de Vasconcelos Generoso S, Lima AS, Correia MITD. Energy balance and nutrition status: a prospective assessment of patients undergoing liver transplantation. Nutrition in Clinical Practice. 2020;35(1):126-32.
  • Ramachandran G, Pottakkat B. Nutritional therapy to cirrhotic patients on transplantation waiting lists. Journal of Liver Transplantation. 2022;5:100060.
  • Sanchez AJ, Aranda‐Michel J. Nutrition for the liver transplant patient. Liver transplantation. 2006;12(9):1310-6.
  • Hsu Y-M, Kuan H-C, Chen Y-A, Chiu C-W, Chen P-C, Tam K-W. Effects of Branched-Chain Amino Acids on Patients Undergoing Hepatic Intervention: A Meta-Analysis of Randomized Controlled Trials. 2022.
  • Trigui A, Rose CF, Bémeur C. Nutritional Strategies to Manage Malnutrition and Sarcopenia following Liver Transplantation: A Narrative Review. Nutrients. 2023;15(4):903.
  • Lattanzi B, Giusto M, Albanese C, Mennini G, D’Ambrosio D, Farcomeni A, et al. The effect of 12 weeks of β-hydroxy-β-methyl-butyrate supplementation after liver transplantation: a pilot randomized controlled study. Nutrients. 2019;11(9):2259.
  • Trovato F, Artru F. Nutritional optimization in liver transplant patients: from the pre-transplant setting to post-transplant outcome. Acta Gastro Enterologica Belgica. 2023;86:335-42.
  • Richardson RA, Garden OJ, Davidson HI. Reduction in energy expenditure after liver transplantation. Nutrition. 2001;17(7-8):585-9.
  • Egashira K, Sasaki H, Higuchi S, Ieiri I. Food-drug interaction of tacrolimus with pomelo, ginger, and turmeric juice in rats. Drug metabolism and pharmacokinetics. 2012;27(2):242-7.
  • Zhang C, Chen B, Jiao A, Li F, Wang B, Sun N, et al. The benefit of immunonutrition in patients undergoing hepatectomy: a systematic review and meta-analysis. Oncotarget. 2017;8(49):86843.
  • Plank LD, Mathur S, Gane EJ, Peng SL, Gillanders LK, McIlroy K, et al. Perioperative immunonutrition in patients undergoing liver transplantation: a randomized double‐blind trial. Hepatology. 2015;61(2):639-47.
  • Qiu Y, Zhu X, Wang W, Xu Q, Ding Y, editors. Nutrition support with glutamine dipeptide in patients undergoing liver transplantation. Transplantation proceedings; 2009: Elsevier.
  • Kamo N, Kaido T, Hamaguchi Y, Uozumi R, Okumura S, Kobayashi A, et al. Impact of enteral nutrition with an immunomodulating diet enriched with hydrolyzed whey peptide on infection after liver transplantation. World Journal of Surgery. 2018;42:3715-25.
  • Kaido T, Ogura Y, Ogawa K, Hata K, Yoshizawa A, Yagi S, et al. Effects of post-transplant enteral nutrition with an immunomodulating diet containing hydrolyzed whey peptide after liver transplantation. World journal of surgery. 2012;36:1666-71.
  • Zhu X, Wu Y, Qiu Y, Jiang C, Ding Y. Effects of ω‐3 fish oil lipid emulsion combined with parenteral nutrition on patients undergoing liver transplantation. Journal of Parenteral and Enteral Nutrition. 2013;37(1):68-74.
  • Ibrahim ES, Saleh SM, Mohamed E, Ahmed E. Effect of omega-3 on hepatic regeneration in adult living donors undergoing hepatic resections for liver transplantation: A randomized controlled trial. Journal of Critical Care. 2016;31(1):157-62.
  • Gao B, Luo J, Liu Y, Zhong F, Yang X, Gan Y, et al. Clinical efficacy of perioperative immunonutrition containing omega-3-fatty acids in patients undergoing hepatectomy: A systematic review and meta-analysis of randomized controlled trials. Annals of Nutrition and Metabolism. 2021;76(6):375-86.
  • Russell K, Zhang H-G, Gillanders LK, Bartlett AS, Fisk HL, Calder PC, et al. Preoperative immunonutrition in patients undergoing liver resection: a prospective randomized trial. World Journal of Hepatology. 2019;11(3):305.
  • Beevi SS S, Pottakkat B (March 30, 2023) Effect of Immunonutrition on the Liver Function Status of End-Stage Liver Disease Patients Waiting/Referred for Liver Transplant: A Randomized Controlled Trial. Cureus 15(3): e36923. DOI 10.7759/cureus.36923.
  • Assimakopoulos SF, Bhagani S, Aggeletopoulou I, Tsounis EP, Tsochatzis EA. The role of gut barrier dysfunction in postoperative complications in liver transplantation: Pathophysiological and therapeutic considerations. Infection. 2024:1-14.
  • Ma M, Wang X, Li J, Jiang W. Efficacy and safety of probiotics and prebiotics in liver transplantation: A systematic review and meta‐analysis. Nutrition in Clinical Practice. 2021;36(4):808-19.
  • Xu X, Zhang C, Tang G, Wang N, Feng Y. Updated Insights into Probiotics and Hepatobiliary Diseases. Biomedicines. 2024;12(3):515.
  • Grąt M, Wronka KM, Lewandowski Z, Grąt K, Krasnodębski M, Stypułkowski J, et al. Effects of continuous use of probiotics before liver transplantation: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition. 2017;36(6):1530-9.
There are 46 citations in total.

Details

Primary Language Turkish
Subjects Nutritional Science
Journal Section Review
Authors

Yağmur Pınar Akkoyun 0000-0002-9380-5304

İrem Olcay Eminsoy 0000-0002-3621-0662

Publication Date January 31, 2025
Submission Date January 23, 2024
Acceptance Date September 4, 2024
Published in Issue Year 2025 Volume: 10 Issue: 1

Cite

APA Akkoyun, Y. P., & Olcay Eminsoy, İ. (2025). Karaciğer Transplantasyonunda Beslenme Durumu ve İmmünonütrisyonun Etkisi. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 10(1), 135-142. https://doi.org/10.61399/ikcusbfd.1424597
AMA Akkoyun YP, Olcay Eminsoy İ. Karaciğer Transplantasyonunda Beslenme Durumu ve İmmünonütrisyonun Etkisi. İKÇÜSBFD. January 2025;10(1):135-142. doi:10.61399/ikcusbfd.1424597
Chicago Akkoyun, Yağmur Pınar, and İrem Olcay Eminsoy. “Karaciğer Transplantasyonunda Beslenme Durumu Ve İmmünonütrisyonun Etkisi”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 10, no. 1 (January 2025): 135-42. https://doi.org/10.61399/ikcusbfd.1424597.
EndNote Akkoyun YP, Olcay Eminsoy İ (January 1, 2025) Karaciğer Transplantasyonunda Beslenme Durumu ve İmmünonütrisyonun Etkisi. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 10 1 135–142.
IEEE Y. P. Akkoyun and İ. Olcay Eminsoy, “Karaciğer Transplantasyonunda Beslenme Durumu ve İmmünonütrisyonun Etkisi”, İKÇÜSBFD, vol. 10, no. 1, pp. 135–142, 2025, doi: 10.61399/ikcusbfd.1424597.
ISNAD Akkoyun, Yağmur Pınar - Olcay Eminsoy, İrem. “Karaciğer Transplantasyonunda Beslenme Durumu Ve İmmünonütrisyonun Etkisi”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 10/1 (January 2025), 135-142. https://doi.org/10.61399/ikcusbfd.1424597.
JAMA Akkoyun YP, Olcay Eminsoy İ. Karaciğer Transplantasyonunda Beslenme Durumu ve İmmünonütrisyonun Etkisi. İKÇÜSBFD. 2025;10:135–142.
MLA Akkoyun, Yağmur Pınar and İrem Olcay Eminsoy. “Karaciğer Transplantasyonunda Beslenme Durumu Ve İmmünonütrisyonun Etkisi”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, vol. 10, no. 1, 2025, pp. 135-42, doi:10.61399/ikcusbfd.1424597.
Vancouver Akkoyun YP, Olcay Eminsoy İ. Karaciğer Transplantasyonunda Beslenme Durumu ve İmmünonütrisyonun Etkisi. İKÇÜSBFD. 2025;10(1):135-42.



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