Abstract
Background: Protein-energy malnutrition is common in patients with end-stage liver disease undergoing liver transplantation. We examined the characteristics of nutritional status and impact of pre-admission branched-chainamino- acids treatment on skeletal muscle mass, nutritional/metabolic parameters and on post-transplant outcomes. Methodology: Preoperative skeletal muscle mass and nutritional/metabolic parameter levels were compared in 129 patients undergoing adult-to-adult living donor liver transplantation whether received branched-chain-aminoacids treatment before admission or not. We examined relationships among these parameters, and risk factors for post-transplant bacteremia and early mortality after LT focusing on nutritional parameters. Results: Pre-albumin and branched-chain-amino-acids-to-tyrosine ratio were significantly higher while tyrosine was lower in branched-chain-amino-acids-pre-supplemented than non-pre-supplemented group, while skeletal muscle mass, total lymphocyte count, zinc, branched-chain-amino-acids and ammonia levels were not significantly different. Skeletal muscle mass positively correlated with tyrosine (r=0.437, P<0.001) and branched-chain-aminoacids (r=0.282, P=0.001) and negatively with branched-chain-amino-acids-to-tyrosine-ratio (r=-0.259, P=0.003). Multivariate predictors of post-transplant bacteremia were: Child-Pugh class C (P=0.012), low preoperative total lymphocyte count (P=0.027), operative blood loss ≥ 10 L (P=0.039) and absence of pre-admission branched-chainamino- acids treatment (P=0.040). Nutritional/metabolic parameters and pre-admission branched-chain-amino-acids treatment were not crucial for post-transplant early mortality. Conclusion: Pre-admission branched-chain-amino-acid therapy could ameliorate preoperative amino acid imbalance and the incidence of post-transplant bacteremia.
Highlights
Derangements of various serum biochemical nutritional parameters including zinc, pre-albumin, branched-chain amino acids (BCAA), tyrosine, total lymphocyte count and the related metabolic parameters as the molar ratio of BCAA-to-tyrosine (BTR) and ammonia, are not uncommon in patients with end-stage liver disease undergoing liver transplantation (LT) due to hepatic debilitating pathology and its medical management [1,2,3,4,5].Patients with decompensated liver cirrhosis frequently receive nutritional therapy with a nutrient mixture enriched with BCAA or BCAA nutrients
We recently reported that skeletal muscle mass had a significant negative correlation with BTR and low preoperative skeletal muscle mass to be closely involved with post-transplant mortality [7]
Subgroup analysis showed that skeletal muscle mass remained positively correlated with BCAA in both BCAA-presupplemented group (r=0.257, P=0.039; Figure 1D) and non-presupplemented group (r=0.259, P=0.040; Figure 1E), the correlations between these parameters were weak
Summary
Derangements of various serum biochemical nutritional parameters including zinc, pre-albumin, branched-chain amino acids (BCAA), tyrosine, total lymphocyte count and the related metabolic parameters as the molar ratio of BCAA-to-tyrosine (BTR) and ammonia, are not uncommon in patients with end-stage liver disease undergoing liver transplantation (LT) due to hepatic debilitating pathology and its medical management [1,2,3,4,5].Patients with decompensated liver cirrhosis frequently receive nutritional therapy with a nutrient mixture enriched with BCAA or BCAA nutrients. Derangements of various serum biochemical nutritional parameters including zinc, pre-albumin, branched-chain amino acids (BCAA), tyrosine, total lymphocyte count and the related metabolic parameters as the molar ratio of BCAA-to-tyrosine (BTR) and ammonia, are not uncommon in patients with end-stage liver disease undergoing liver transplantation (LT) due to hepatic debilitating pathology and its medical management [1,2,3,4,5]. BCAA treatment on both skeletal muscle mass and nutritional/. We assessed relationships among these parameters, especially with skeletal muscle mass and zinc levels, and examined risk factor for bacteremia. Protein-energy malnutrition is common in patients with end-stage liver disease undergoing liver transplantation. We examined the characteristics of nutritional status and impact of pre-admission branched-chainamino-acids treatment on skeletal muscle mass, nutritional/metabolic parameters and on post-transplant outcomes
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