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Perioperative immunonutrition in patients undergoing liver transplantation: A randomized double-blind trial

Perioperative immunonutrition in patients undergoing liver transplantation: A randomized double-blind trial
Perioperative immunonutrition in patients undergoing liver transplantation: A randomized double-blind trial
Preliminary work suggested that perioperative immunonutrition (IMN) enriched in n-3 fatty acids, arginine, and nucleotides may improve preoperative nutritional status, enhance postoperative recovery, and reduce postoperative infectious complications in patients undergoing liver transplantation (LT). The current study examined these outcomes in a double-blind, randomized, controlled trial. Patients wait-listed for LT (n?=?120) were randomized to either supplemental (0.6 L/d) oral IMN or an isocaloric control (CON). Enteral IMN or CON was resumed postoperatively and continued for at least 5 days. The change in total body protein (TBP) measured by neutron activation from study entry until immediately prior to LT was the primary endpoint and TBP measurements were repeated 10, 30, 90, 180, and 360 days after LT. Infectious complications were recorded for the first 30 postoperative days. Nineteen patients died or were delisted prior to LT. Fifty-two IMN and 49 CON patients received supplemental nutrition for a median (range) 56 (0-480) and 65 (0-348) days, respectively. Preoperative changes in TBP were not significant (IMN: 0.06?±?0.15 [SEM]; CON: 0.12?±?0.10 kg). Compared to baseline, a 0.7?±?0.2 kg loss of TBP was seen in both groups at 30 days after LT (P?<?0.0001) and, at 360 days, TBP had not increased significantly (IMN: 0.08?±?0.19 kg; CON: 0.26?±?0.23 kg). Infectious complications occurred in 31 (60%) IMN and 28 (57%) CON patients (P?=?0.84). The median (range) postoperative hospital stay was 10 (5-105) days for IMN and 10 (6-27) days for CON patients (P?=?0.68). Conclusion: In patients undergoing LT, perioperative IMN did not provide significant benefits in terms of preoperative nutritional status or postoperative outcome.
0270-9139
639-647
Plank, L.D.
85ff1dc0-7576-4da1-8d60-34464b1365a3
Mathur, S.
994501a8-4b9c-4bb7-8565-46be9203f195
Gane, E.J.
bef165c8-8cbc-4b7e-b71d-d547a343bf7f
Peng, S.
f528ca42-cd0c-4bcd-90f3-a20a2410a851
Gillanders, L.K.
c8543d79-64ce-4321-aa77-775216ed2504
McIlroy, K.
1474f65b-7773-4344-a087-44d4dcadac50
Calder, P.C.
1797e54f-378e-4dcb-80a4-3e30018f07a6
McCall, J.L.
e12ed78b-8a78-4059-bc51-3d4cfb2ef1ed
Chavez, C.P.
89309d7d-46e5-4de7-8900-0be2a58156ed
Plank, L.D.
85ff1dc0-7576-4da1-8d60-34464b1365a3
Mathur, S.
994501a8-4b9c-4bb7-8565-46be9203f195
Gane, E.J.
bef165c8-8cbc-4b7e-b71d-d547a343bf7f
Peng, S.
f528ca42-cd0c-4bcd-90f3-a20a2410a851
Gillanders, L.K.
c8543d79-64ce-4321-aa77-775216ed2504
McIlroy, K.
1474f65b-7773-4344-a087-44d4dcadac50
Chavez, C.P.
89309d7d-46e5-4de7-8900-0be2a58156ed
Calder, P.C.
1797e54f-378e-4dcb-80a4-3e30018f07a6
McCall, J.L.
e12ed78b-8a78-4059-bc51-3d4cfb2ef1ed

Plank, L.D., Mathur, S., Gane, E.J., Peng, S., Gillanders, L.K., McIlroy, K., Calder, P.C. and McCall, J.L. , Chavez, C.P. (ed.) (2015) Perioperative immunonutrition in patients undergoing liver transplantation: A randomized double-blind trial. Hepatology, 61 (2), 639-647. (doi:10.1002/hep.27433). (PMID:25212278)

Record type: Article

Abstract

Preliminary work suggested that perioperative immunonutrition (IMN) enriched in n-3 fatty acids, arginine, and nucleotides may improve preoperative nutritional status, enhance postoperative recovery, and reduce postoperative infectious complications in patients undergoing liver transplantation (LT). The current study examined these outcomes in a double-blind, randomized, controlled trial. Patients wait-listed for LT (n?=?120) were randomized to either supplemental (0.6 L/d) oral IMN or an isocaloric control (CON). Enteral IMN or CON was resumed postoperatively and continued for at least 5 days. The change in total body protein (TBP) measured by neutron activation from study entry until immediately prior to LT was the primary endpoint and TBP measurements were repeated 10, 30, 90, 180, and 360 days after LT. Infectious complications were recorded for the first 30 postoperative days. Nineteen patients died or were delisted prior to LT. Fifty-two IMN and 49 CON patients received supplemental nutrition for a median (range) 56 (0-480) and 65 (0-348) days, respectively. Preoperative changes in TBP were not significant (IMN: 0.06?±?0.15 [SEM]; CON: 0.12?±?0.10 kg). Compared to baseline, a 0.7?±?0.2 kg loss of TBP was seen in both groups at 30 days after LT (P?<?0.0001) and, at 360 days, TBP had not increased significantly (IMN: 0.08?±?0.19 kg; CON: 0.26?±?0.23 kg). Infectious complications occurred in 31 (60%) IMN and 28 (57%) CON patients (P?=?0.84). The median (range) postoperative hospital stay was 10 (5-105) days for IMN and 10 (6-27) days for CON patients (P?=?0.68). Conclusion: In patients undergoing LT, perioperative IMN did not provide significant benefits in terms of preoperative nutritional status or postoperative outcome.

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More information

Accepted/In Press date: 7 September 2014
e-pub ahead of print date: 5 January 2015
Published date: February 2015
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 373742
URI: http://eprints.soton.ac.uk/id/eprint/373742
ISSN: 0270-9139
PURE UUID: d2d1e7b7-e64c-4074-b7fa-4113359fa1c2
ORCID for P.C. Calder: ORCID iD orcid.org/0000-0002-6038-710X

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Date deposited: 27 Jan 2015 11:25
Last modified: 15 Mar 2024 02:50

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Contributors

Author: L.D. Plank
Author: S. Mathur
Author: E.J. Gane
Author: S. Peng
Author: L.K. Gillanders
Author: K. McIlroy
Editor: C.P. Chavez
Author: P.C. Calder ORCID iD
Author: J.L. McCall

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