Nutritional and Dietary Management

Post-transplant

Why What You
Eat Matters
Diets for Different
Transplants
Eating to Avoid
Infections

Why is dietary management important after a transplant?

The purpose of a restricted diet is to prevent infections through food and maintain proper nutritional status by ensuring adequate nutrient intake for patients facing discharge after hematopoietic stem cell transplantation until their immune function improves. Consuming a balanced diet with a variety of nutrients in conjunction with infection control can aid in healing and immune recovery. Although the consumption of instant foods such as ramen is not desirable in terms of nutrition and various other aspects, the possibility of consumption from an infection prevention perspective is explained considering the preferences frequently consumed by Koreans.

The period during which a restricted diet is required varies depending on the type of transplant

The time when a limited diet is required depending on the type of transplant
Types of transplants	Times when a restricted diet is required
Autologous hematopoietic stem cell transplantation	For three months post-transplan (Multiple myeloma continues for 1 month after the transplantation.)
Sibling allogeneic hematopoietic stem cell transplantation	Until the end of immunosuppressant therapy (approximately 6 months)
Non-sibling allogeneic hematopoietic stem cell transplantation	Until the end of immunosuppressant therapy (approximately 12 months)
Family mismatched hematopoietic stem cell transplantation
Cord blood hematopoietic stem cell transplantation

* The period during which a restricted diet is required is generally dependent on the recovery of immune function after transplantation. Therefore, the range of restricted foods and the duration of restrictions can be adjusted by the attending physician based on the patient's individual recovery status and the presence and severity of graft-versus-host disease (GVHD) after transplantation.

What are the dietary guidelines for preventing infections

At the time of purchase

1.
Always check the packaging, condition of the food, and expiration date.
2.
Use individually packaged foods to reduce the opportunity for contamination that can occur from handling the food multiple times.
3.
Purchase meat, fish, and poultry separately packaged to prevent mixing with other foods.
4.
Do not purchase foods that are eaten raw and have been pre-cut. (e.g., watermelon, melon)
5.
Purchase food that has been stored at the appropriate temperature. (e.g., buy eggs that have been refrigerated)
6.
When shopping for food, buy refrigerated and frozen items last.
7.
Do not consume food samples.

When cooking

1.
Before preparing food, make sure to thoroughly wash your hands first.
2.
During cooking, it is crucial to wash your hands thoroughly before and after handling unhygienic objects or uncooked meat, fish, poultry, and seaweed.
3.
Ensure that the area where you are preparing food is cleaned beforehand.
4.
Patients are advised not to handle food ingredients directly.
5.
All food ingredients should be thoroughly washed under running water before use.
6.
Choose fresh ingredients and prepare them right before eating.
7.
Meat and fish should be fully defrosted before cooking and then thoroughly cooked. Do not defrost at room temperature and avoid refreezing after defrosting in the refrigerator.
8.
Use cutting boards made of plastic or glass, not wood. Differentiate between the cutting boards used for vegetables, meat, etc., and clean and sterilize them after each use.
9.
As much as possible, food should be cooked using heat.

Storage

1.
Avoid consuming food that has been left out at room temperature for more than 2 hours.
2.
Rice can be stored in a heated rice cooker for up to 24 hours.
3.
Cooked food can be refrigerated for up to 24 hours, and it must be reheated before consumption. When reheating stored food, bring it to a boil first, stir thoroughly, and then continue to boil for about 5 more minutes. (Ideally, prepare food in single servings to avoid leftovers.)
4.
When storing food in the refrigerator, keep cooked and raw foods in separate compartments. (Store the cooked food on the upper shelves.)

Restricted Foods and Permitted Foods

1.
The range of permissible and restricted foods, as presented in the table on the following page, may vary depending on the patient's individual condition and host responses.
2.
Note! Even if food restrictions are lifted, alcohol, cigarettes, street food, junk food, medicinal mushrooms, and herbal medicine, as well as raw fish (sashimi), continue to be restricted.

permissible/restricted food for infection prevention
Food group	Permitted Foods	Restricted Foods
Grains	Cooked grains (rice, noodles, potatoes, sweet potatoes, corn, etc.) Single-serving sealed-packaged cereals and bread without filling Cooked instant foods (porridge, curry, soup, ramen, etc.) Sealed-packaged cream, Snacks without jam gum, chocolate	Raw grains (such as cereal) and dried grains (such as dried radish) Displayed breads and breads with fillings (such as cream, sweet red bean paste, etc.) Instant foods and cup noodles containing shellfish (such as mussels, abalone, oysters, etc.) Biscuits with cream or jam(like sandwich buscuits) Candy with fillings, Gum and chocolate containing fruits or nuts
Fish and meat	Cooked meats, fish, eggs, tofu, seafood (excluding restricted foods) dried fish, and processed meats should all be prepared at proper temperatures. The core temperature should reach 75°C (for fish and seafood, 85°C) and be maintained for at least one minute.	Uncooked meat, fish, eggs, tofu, seafood, dried and processed food Including jeotgal (fermented seafood), gopchang/seonji/sundae (offal dishes), dog soup, black goat, chicken feet, pig's feet, shellfish (mussels, abalone, oysters), etc. (even when cooked, these are not recommended)
Vegetables	Vegetables that are peeled before eating (such as cucumbers, radishes, etc.) Cooked vegetables and edible mushrooms cooked seaweed (including single-use roasted seaweed) are recommended	Vegetables that are consumed with their peel on (Including kimchi, pickled radish, and dried radish strips)
Fruits	Fruits that are peeled before eating (such as apples, pears, persimmons, tangerines, peaches, bananas, etc.) Cooked tomatoes Canned fruits are suggested for your diet.	Fruits with no peel or with thin and soft peel(Strawberries, grapes, persimmons, etc.) Dried fruits(Dried jujube, dried grapes, dried persimmons, etc.) Frozen Fruits
Fats	Cooking oils, butter, margarine used for heat cooking Nuts that are packaged in bottles or cans, including those that are cooked, are safe to consume.	Raw pine nuts
Milk products	Sterilized milk Regular milk, pasteurized milk Cooked cheddar slice cheese, pizza cheese, Parmesan cheese Single-use sealed brand of formula Sterilized liquid formula or baby food	Yogurt (liquid), Yogurt (semi-solid) Whipping cream, Ice cream Cheese options excluding certain types (such as aged cheese, cream cheese, cheese dressing, etc.)
Beverages	Boiled water and commercially sold bottled water Beverages packaged individually in bottles or cans Beverages marked as pasteurized/sterilized Room temperature fruit drinks (pack) Boiled green tea Single-use sealed brand of coffee mix Nutritional supplement beverages for patients	Unboiled water (tap water, water from a water purifier, spring water, etc.) Homemade sikhye and sujeonggwa Beverages containing probiotics Mate tea
Others	Heated commercially sold seasonings and sauces Single-use sealed packages of sugar, jam, ketchup, honey mustard, mayonnaise Single-use sealed packages of seasonings and sauces marked as pasteurized/sterilized	Ginseng, red ginseng, and herbal medicine Medicinal mushrooms (such as Reishi, Cordyceps, Agaricus mushrooms, etc.) Boiled water with dried balloon flower root, water dropwort, and dandelion

Others

1.
Boiled water is safe to drink, while bottled water can be consumed directly. However, avoid touching the bottle with your mouth when drinking, and make sure to consume all contents within 4 hours after opening.
2.
Dishes should be wiped with a dry cloth or paper towel, not a damp one.
3.
After use, dishcloths should be sanitized and replaced daily, or you can opt to use disposable ones.
4.
Consuming excessively oily foods (e.g., eel, loach, bear soup) can trigger diarrhea, so it's advisable to consult with your healthcare provider before consumption.
5.
While homemade rice cakes can be eaten immediately, purchased ones should be steamed once more before consumption.
6.
There are no restrictions on the type of branded beverages packaged in bottles or cans. However, choose those packaged in small, single-use containers and consume immediately after opening.
7.
When consuming retort pouch meals, follow the cooking instructions indicated. (However, meals containing shellfish are restricted.)
8.
Branded condiments like jam, ketchup, and mayonnaise that have a long shelf life and can be stored at room temperature are safe to eat immediately after opening if they are individually packaged. Larger containers can only be eaten immediately upon the first opening. If refrigerated after opening, they must be heated before consumption.
9.
Only certain types of cheese, such as cooked cheddar slices, pizza cheese (mozzarella), and Parmesan cheese, are permissible.
10.
It's generally safe to use products from large domestic brands that have a relatively secure hygiene management system. However, be cautious when purchasing food ingredients through home shopping or online shopping, as the hygiene and distribution processes may be unclear.
11.
When dining out, choose well-cooked food types and visit restaurants at less busy times. Only select establishments where you can trust that the food is well-managed and the premises are clean. (In the initial period after discharge, it is recommended to avoid dining out.)
12.
You should not consume cold noodles from restaurants. When preparing at home, it's recommended to opt for warm noodles as much as possible.
13.
When ordering delivery food such as pizza, choose a menu without restricted ingredients (like shellfish) and reheat it in the microwave at home before eating.
14.
For delivery foods like fried chicken or sweet and sour pork, request the sauce and meat to be delivered separately. The meat should be reheated in the microwave, and the sauce should be boiled once on the stove before eating.
15.
Enjoy meals together as a family. When consuming shared soups or stews, serve them separately.
16.
When first adapting, it's recommended to eat small amounts frequently.
17.
Your taste may differ after transplantation. It may take several months or more for your taste to return to normal.
18.
You should take a multivitamin once a day for a year after transplantation.