Characteristics of Nutritional Status and the Effect of Pre-transplant Branched-chain Amino Acid Administration in Patients Undergoing Living Donor Liver Transplantation

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.