Early Enteral Feeding of Daikenchuto Stimulates Early Bowel Movement With Increased Portal Venous Blood Flow After Living Donor Liver Transplantation

• Published in: Transplantation proceedings 2018-11, Vol.50 (9), p.2690-2694
• Main Authors: Usui, M., Hayasaki, A., Fujii, T., Iizawa, Y., Kato, H., Tanemura, A., Murata, Y., Azumi, Y., Kuriyama, N., Kishiwada, M., Mizuno, S., Sakurai, H., Isaji, S.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Defecation - drug effects; Enteral Nutrition - methods; Female; Gastrointestinal Motility - drug effects; Humans; Liver Transplantation - adverse effects; Liver Transplantation - methods; Living Donors; Male; Middle Aged; Mycoses - epidemiology; Mycoses - etiology; Plant Extracts - administration & dosage; Portal Pressure - drug effects; Portal Vein - physiology; Postoperative Period; Prospective Studies; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.03.037

Daikenchuto (DKT), a Japanese Kampo medicine, had been reported to increase small intestinal blood flow after liver resection. The aim of this study was to evaluate the effects of early enteral feeding of DKT on portal venous flow and early bowel movement after living donor liver transplantation (LDLT) in an attempt to clarify whether these effects on bowel motility can prevent bacterial and/or fungal translocation. Our prospective study included the consecutive 16 LDLT recipients at Mie University Hospital between June 2006 and September 2009. Sixteen patients were divided into the 2 groups according to enteral feeding starting postoperative day (POD) 1: 8 patients in DKT (15 g/d) administration (DKT group, for 1 week) and 8 patients in tepid water administration (non-DKT group, for 1 week). Portal venous flow, portal venous pressure, presence of fungal infection (serum level of β-D-glucan and fungal polymerase chain reaction assay), time to first food intake, and time to first defecation were serially examined. Portal venous flow (mean [SD] velocity) was significantly increased in DKT group compared with non-DKT group: 47.5 (12.9) vs 31.8 (15.4) (P = .04) on POD 1, 46.8 (11.5) vs 28.8 (12.5) (P = .03) on POD 3, and 42.3 (17.2) vs 25.2 (9.0) (P = .05) on POD 5. However, mean (SD) portal venous pressures did not significantly change between the 2 groups. Between the 2 groups (DKT vs non-DKT), the day of first oral intake was not significantly different: 6.9 (2.5) vs 11.3 (8.7) (P = .061), but the mean (SD) day of first defecation was significantly shorter in the DKT group: 3.9 (1.1) vs 5.5 (2.6) (P = .02). Although fungal polymerase chain reaction assay was not significantly different between the 2 groups (4 vs 4 positive cases), the mean (SD) serum levels of β-D-glucan were significantly lower in the DKT group than in the non-DKT group: 9.0 (7.4) vs 18.4 (15.9) pg/mL (P = .04). Early enteral feeding of DKT after LDLT increased portal vein blood flow without increasing portal vein pressure and stimulated early bowel movement, which in turn might prevent fungal translocation. •Daikenchuto administration is a useful and effective treatment for postoperative course in living donor liver transplantation.•This is the first report to demonstrate usefulness of daikenchuto after living donor liver transplantation.•The possible mechanism is that increased portal venous flow improves bowel motility, shortens time to first defecation, and may prevent fungal infection