Weight reduction may be necessary in patients with
end-stage liver disease (ESLD) before
liver transplantation. Although very
low calorie diets (VLCDs) are a highly effective
weight loss strategy, they risk inducing
protein-calorie malnutrition,
sarcopenia and
hepatic encephalopathy in ESLD patients. We report for the first time on the use of VCLDs in ESLD. Two severely obese individuals with ESLD underwent a modified VLCD to become eligible for
liver transplantation. Patients consumed four
protein supplements and one lean meal daily, equivalent to 800 kilocalories (kcal) and were closely monitored during the diet period. Subject 1, a 46-year-old male with
alcoholic cirrhosis, lost 44.1 kg after 28 weeks on a modified VLCD. Liver function and MELD (model for
end-stage liver disease) scores improved and he currently does not require listing for
transplantation. Subject 2, a 64-year-old female with non-
alcoholic steatohepatitis, lost 39.7 kg after a 30-week modified VLCD. She is awaiting
liver transplantation listing with a stable MELD score. VLCDs were well tolerated by both patients without adverse effects. In conclusion, under close medical supervision VLCDs in patients with ESLD can be safe and effective in reducing weight, facilitating
liver transplantation listing, and possibly improving liver damage.