Effect of Immunonutrition on the Liver Function Status of End-Stage Liver Disease Patients Waiting/Referred for Liver Transplant: A Randomized Controlled Trial.

Abstract

Background Malnutrition and liver dysfunction are commonly observed in patients with chronic liver disease. With the current surge in liver diseases, prompt nutritional planning will ensure the well-being of patients during the waiting period and will improve the clinical outcomes following liver transplantation (LT). We conducted this study to monitor the effect of immunonutrition on liver function parameters among end-stage liver disease (ESLD) patients referred for LT. Methodology In this randomized controlled trial, 144 ESLD patients who met the inclusion criteria were randomly enrolled into control (CON) and intervention (INT) groups after obtaining informed consent. Three patients were lost to follow-up due to the COVID-19 lockdown. The INT group(n = 69) was provided with 100 g of immunonutrient and the CON group (n = 72)was provided with supervised diet advice. Liver function test (LFT) parameters such as total protein, albumin, total bilirubin, direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, and prothrombin time/international normalized ratio before and after therapy at one month were checked in both groups. Results The majority of patients with the disease were males (83.3% in the CON group vs 76.8% in the INT group), having alcoholism as the etiology in both groups with 45.8% in the CON group and 56.5% in the INT group. Thecomparison of LFT parameters among ESLD patients during pre and post-therapy between the control and immunonutrition groups did not show any statistically significant difference in the LFT parameters between the INT and CON groups both at baseline and at one month. Conclusions The impact of immunonutrition on ESLD patients awaiting LT compared to supervised diet advice did not significantly improve liver function. The liver disease itself profoundly affects the level of nutrition; hence, nutritional assessment and early nutritional interventions can be instituted to improve clinical outcomes.