Branched-chain amino acid-enriched nutrients improve nutritional and metabolic abnormalities in the early post-transplant period after living donor liver transplantation

• Published in: Journal of hepato-biliary-pancreatic sciences 2012-07, Vol.19 (4), p.438-448
• Main Authors: Yoshida, Ryuichi, Yagi, Takahito, Sadamori, Hiroshi, Matsuda, Hiroaki, Shinoura, Susumu, Umeda, Yuzo, Sato, Daisuke, Utsumi, Masashi, Nagasaka, Takeshi, Okazaki, Nami, Date, Ai, Noguchi, Ayako, Tanaka, Akemi, Hasegawa, Yuko, Sakamoto, Yachiyo, Fujiwara, Toshiyoshi
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Amino Acids, Branched-Chain - therapeutic use; branched-chain amino-acid-enriched nutrients; Calorimetry, Indirect; Dietary Supplements; Energy Metabolism; Enteral Nutrition; Female; Gastroenterology; Hepatology; Humans; Liver Diseases - metabolism; Liver Diseases - therapy; Liver Regeneration; Liver Transplantation; living donor liver transplantation; Living Donors; Male; Medicine; Medicine & Public Health; Middle Aged; non-protein respiratory quotient; Nutritional Status; Original Article; perioperative nutrition; Pilot Projects; Postoperative Period; Prospective Studies; Surgical Oncology
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1007/s00534-011-0459-5

Background/purpose Malnutrition and metabolic disorder of patients undergoing living donor liver transplantation (LDLT) can affect post-transplant prognosis. The aim of this study was to establish whether perioperative usage of branched-chain amino-acid (BCAA)-enriched nutrients improve metabolic abnormalities of patients undergoing LDLT. Methods We designed a randomized pilot study (UMIN registration number; 000004323). Twenty-five consecutive adult elective LDLT recipients were enroled and divided into two groups: the BCAA group (BCAA-enriched nutrients, n  = 12) and the control group (standard diet, n  = 13). Metabolic and nutritional parameters, including BCAA-to-tyrosine ratio (BTR), retinol binding protein (RBP), and prealbumin were regularly measured from 1 week before to 4 weeks after LDLT. Non-protein respiratory quotient (npRQ) was measured before and 4 weeks after LDLT. Results BTR and RBP improved considerably in the BCAA group compared with the controls. npRQ significantly increased from 1 week before LDLT to 4 weeks after LDLT in the BCAA group (0.77 ± 0.05 to 0.84 ± 0.06, P  = 0.002), but not in the control group (0.78 ± 0.04 to 0.81 ± 0.05). Conclusions Supplementation with BCAA-enriched nutrients might improve persistent nutritional and metabolic disorders associated with end-stage liver disease in the early post-transplant period, and consequently shorten the post-transplant catabolic phase after LDLT. A larger multicenter trial is needed to confirm these findings.