Effect of perioperative nutritional support on protein metabolism and immunity in patients underwent liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Xiao ¹ , SUN Lin ² , FU Xiaoyue ¹ ,  ZANG Yunjin ¹

1. Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R.China;
2. ICU, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R.China;

Corresponding author：

ZANG Yunjin, Email: zangyj3657@qq.com

Keywords：

nutritional support; liver transplantation; perioperative period; protein metabolism; immune function

DOI：

10.7507/1007-9424.201607092

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Objective To study the effect of perioperative nutritional support on protein metabolism and immunity in patients underwent liver transplantation. Methods A total of 80 patients who underwent liver transplantation in our hospital from March 2015 to March 2016 were collected retrospectively, and then the 80 patients were divided into control group (n=40) and observation group (n=40) according to the type of perioperative nutritional support. Patients of control group didn’t receive preoperatively nutritional support, and received total parenteral nutrition support before postoperative exhaust, then received enteral nutrition support after anal exhaust. Patients of observation group receive preoperatively nutritional support before surgery, and received parenteral nutrition and enteral nutrition support before postoperative exhaust. The several parameters about nutritional status and immune function were observed on 7 days and 14 days after liver transplantation, and comparison of the 2 group in these parameters was performed. Results On the protein metabolism, the levels of serum transferrin, prealbumin, and nitrogen balance on 14 days after liver transplantation were higher than those of other time points (before liver transplantation and 7 days after liver transplantation),P<0.05, both in control group and observation group. There was no significant difference in the levels of serum transferrin, prealbumin, and value of nitrogen balance between the 2 groups before liver transplantation (P>0.05). But on 7 days and 14 days after liver transplantation, the levels of serum transferrin, prealbumin, and value of nitrogen balance of the observation group were higher than those of control group (P<0.05). On the immunity, the total number of lymphocytes, value of IgG and CD₄/CD₈ on 14 days after liver transplantation, were superior to other time points (before liver transplantation and 7 days after liver transplantation),P<0.05, both in control group and observation group. There was no significant difference in the total number of lymphocytes, value of IgG and CD₄/CD₈ between the 2 groups before liver transplantation (P>0.05). But on 7 days and 14 days after liver transplantation, the levels of the total number of lymphocytes, value of IgG and CD₄/CD₈ in the observation group were superior to those of control group (P<0.05). Conclusion Perioperative nutritional support can improve the nutritional status and immune function in patients underwent liver transplantation.

Citation： HU Xiao, SUN Lin, FU Xiaoyue, ZANG Yunjin. Effect of perioperative nutritional support on protein metabolism and immunity in patients underwent liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(3): 338-342. doi: 10.7507/1007-9424.201607092 Copy

1.	郑树森. 肝脏移植. 北京: 人民卫生出版社, 2001: 251-252.
2.	周旭, 刘军, 杨凤辉, 等. 不同脂肪组分营养支持影响肝移植病人蛋白质代谢的临床研究. 中国实用外科杂志, 2010, 30(6): 480-483.
3.	Kerwin AJ, Nussbaum MS. Adjuvant nutrition management of patients with liver failure, including transplant. Surg Clin North Am, 2011, 91(3): 565-578.
4.	Merli M, Giusto M, Gentili F,et al. Nutritional status: its influence on the outcome of patients undergoing liver transplantation. Liver Int, 2010, 30(2): 208-214.
5.	Vera A, Contreras F, Guevara F. Incidence and risk factors for infections after liver transplant: single-center experience at the University Hospital Fundación Santa Fe de Bogotá, Colombia. Transpl Infect Dis, 2011, 13(6): 608-615.
6.	Kaido T, Mori A, Ogura Y,et al. Impact of enteral nutrition using a new immuno-modulating diet after liver transplantation. Hepatogastroenterology, 2010, 57(104): 1522-1525.
7.	史长城, 林东海, 翁哮华, 等. 肝移植术后营养支持的研究进展. 肠外与肠内营养, 2012, 19(3): 188-190.
8.	Yoshida R, Yagi T, Sadamori H,et al. Branched-chain amino acid-enriched nutrients improve nutritional and metabolic abnormalities in the early post-transplant period after living donor liver transplantation. J Hepatobiliary Pancreat Sci, 2012, 19(4): 438-448.
9.	黎介寿. 肠内营养——外科临床营养支持的首选途径. 中国实用外科杂志, 2003, 23(2): 67-69.
10.	Horster S, Bäuerlein FJ, Mandel P,et al. Influence of hepatitis C virus infection and high virus serum load on biliary complications in liver transplantation. Transpl Infect Dis, 2013, 15(3): 306-313.
11.	Kinner S, Umutlu L, Dechêne A,et al. Biliary complications after liver transplantation: addition of T1-weighted images to MR cholangiopancreatography facilitates detection of cast in biliary cast syndrome. Radiology, 2012, 263(2): 429-436.
12.	López-Benítez R, Wielpütz MO, Bryant MG,et al. Percutaneous treatment of biliary cast syndrome after orthotopic liver transplantation: comparison of mechanicalversus hydraulic rheolytic cast extraction. Cardiovasc Intervent Radiol, 2011, 34(5): 998-1005.
13.	Paik WH, Lee SH, Ryu JK,et al. Long-term clinical outcomes of biliary cast syndrome in liver transplant recipients. Liver Transpal, 2013, 19(3): 275-282.
14.	Farid WR, de Jonge J, Slieker JC,et al. The importance of portal venous blood flow in ischemic-type biliary lesions after liver transplantation. Am J Transplant, 2011, 11(4): 857-862.
15.	Koo JW, Jang NE, Lee HJ,et al. A case of biliary cast developed in a patient with long-standing biliary sludge. Clin Endosc, 2013, 46(1): 98-101.
16.	朱晓丹, 沈中阳, 臧运金, 等. 肝移植后胆道铸型 4 例全蛋白质的表达. 中国组织工程研究与临床康复, 2010, 14(18): 3401-3404.
17.	易波, 叶启发, 成科, 等. 肾移植术后重症肺部感染病人营养支持对免疫功能影响的临床研究. 中国现代医学杂志, 2009, 19(7): 1078-1080.
18.	江涛, 王轩, 张斌, 等. 谷氨酰胺联合生长激素在肝移植病人术后应用的临床研究. 肠外与肠内营养, 2011, 18(2): 71-74.
19.	阳文新, 钟正江, 曹耀军, 等. 早期肠内营养支持在肝癌患者肝移植术后的应用. 临床肿瘤学杂志, 2009, 14(9): 827-830.
20.	施晓雷, 任昊桢, 吴亚夫, 等. 肠外联合肠内营养支持在肝功能衰竭病人肝移植术后的应用. 肠外与肠内营养, 2013, 20(6): 324-327.
21.	Taha AM, Sharif K, Johnson T,et al. Long-term outcomes of isolated liver transplantation for short bowel syndrome and intestinal failure-associated liver disease. J Pediatr Gastroenterol Nutr, 2012, 54(4): 547-551.
22.	李琳. 重视肝移植术后早期肠内营养支持// 中华医学会肠外肠内营养学分会第八届全国肠外肠内营养学术大会论文集, 2014: 494-495.
23.	Kerwin AJ, Nussbaum MS. Adjuvant nutrition management of patients with liver failure, including transplant. Surg Clin North Am, 2011, 91(3): 565-578.
24.	吕少诚, 史宪杰, 梁雨荣, 等. 肝移植术后的早期肠内营养支持治疗: 附 86 例报告. 中华肝胆外科杂志, 2012, 18(9): 692-695.
25.	黄伟, 王毅, 谷斌斌, 等. 肝移植术后的营养支持治疗. 上海预防医学, 2013, 25(5): 269-271.
26.	Binhas M, Amathieu R, Campillo B,et al. French survey on perioperative nutrition in cirrhotic adult patients waiting for liver transplantation. Ann Fr Anesth Reanim, 2013, 32(5): 302-306.
27.	Oh PS, Fingeret AL, Shah MY,et al. Improved tolerance for enteral nutrition after serial transverse enteroplasty (STEP) in infants and children with short bowel syndrome–a seven-year single-center experience. J Pediatr Surg, 2014, 49(11): 1589-1592.

1. 郑树森. 肝脏移植. 北京: 人民卫生出版社, 2001: 251-252.
2. 周旭, 刘军, 杨凤辉, 等. 不同脂肪组分营养支持影响肝移植病人蛋白质代谢的临床研究. 中国实用外科杂志, 2010, 30(6): 480-483.
3. Kerwin AJ, Nussbaum MS. Adjuvant nutrition management of patients with liver failure, including transplant. Surg Clin North Am, 2011, 91(3): 565-578.
4. Merli M, Giusto M, Gentili F,et al. Nutritional status: its influence on the outcome of patients undergoing liver transplantation. Liver Int, 2010, 30(2): 208-214.
5. Vera A, Contreras F, Guevara F. Incidence and risk factors for infections after liver transplant: single-center experience at the University Hospital Fundación Santa Fe de Bogotá, Colombia. Transpl Infect Dis, 2011, 13(6): 608-615.
6. Kaido T, Mori A, Ogura Y,et al. Impact of enteral nutrition using a new immuno-modulating diet after liver transplantation. Hepatogastroenterology, 2010, 57(104): 1522-1525.
7. 史长城, 林东海, 翁哮华, 等. 肝移植术后营养支持的研究进展. 肠外与肠内营养, 2012, 19(3): 188-190.
8. Yoshida R, Yagi T, Sadamori H,et al. Branched-chain amino acid-enriched nutrients improve nutritional and metabolic abnormalities in the early post-transplant period after living donor liver transplantation. J Hepatobiliary Pancreat Sci, 2012, 19(4): 438-448.
9. 黎介寿. 肠内营养——外科临床营养支持的首选途径. 中国实用外科杂志, 2003, 23(2): 67-69.
10. Horster S, Bäuerlein FJ, Mandel P,et al. Influence of hepatitis C virus infection and high virus serum load on biliary complications in liver transplantation. Transpl Infect Dis, 2013, 15(3): 306-313.
11. Kinner S, Umutlu L, Dechêne A,et al. Biliary complications after liver transplantation: addition of T1-weighted images to MR cholangiopancreatography facilitates detection of cast in biliary cast syndrome. Radiology, 2012, 263(2): 429-436.
12. López-Benítez R, Wielpütz MO, Bryant MG,et al. Percutaneous treatment of biliary cast syndrome after orthotopic liver transplantation: comparison of mechanicalversus hydraulic rheolytic cast extraction. Cardiovasc Intervent Radiol, 2011, 34(5): 998-1005.
13. Paik WH, Lee SH, Ryu JK,et al. Long-term clinical outcomes of biliary cast syndrome in liver transplant recipients. Liver Transpal, 2013, 19(3): 275-282.
14. Farid WR, de Jonge J, Slieker JC,et al. The importance of portal venous blood flow in ischemic-type biliary lesions after liver transplantation. Am J Transplant, 2011, 11(4): 857-862.
15. Koo JW, Jang NE, Lee HJ,et al. A case of biliary cast developed in a patient with long-standing biliary sludge. Clin Endosc, 2013, 46(1): 98-101.
16. 朱晓丹, 沈中阳, 臧运金, 等. 肝移植后胆道铸型 4 例全蛋白质的表达. 中国组织工程研究与临床康复, 2010, 14(18): 3401-3404.
17. 易波, 叶启发, 成科, 等. 肾移植术后重症肺部感染病人营养支持对免疫功能影响的临床研究. 中国现代医学杂志, 2009, 19(7): 1078-1080.
18. 江涛, 王轩, 张斌, 等. 谷氨酰胺联合生长激素在肝移植病人术后应用的临床研究. 肠外与肠内营养, 2011, 18(2): 71-74.
19. 阳文新, 钟正江, 曹耀军, 等. 早期肠内营养支持在肝癌患者肝移植术后的应用. 临床肿瘤学杂志, 2009, 14(9): 827-830.
20. 施晓雷, 任昊桢, 吴亚夫, 等. 肠外联合肠内营养支持在肝功能衰竭病人肝移植术后的应用. 肠外与肠内营养, 2013, 20(6): 324-327.
21. Taha AM, Sharif K, Johnson T,et al. Long-term outcomes of isolated liver transplantation for short bowel syndrome and intestinal failure-associated liver disease. J Pediatr Gastroenterol Nutr, 2012, 54(4): 547-551.
22. 李琳. 重视肝移植术后早期肠内营养支持// 中华医学会肠外肠内营养学分会第八届全国肠外肠内营养学术大会论文集, 2014: 494-495.
23. Kerwin AJ, Nussbaum MS. Adjuvant nutrition management of patients with liver failure, including transplant. Surg Clin North Am, 2011, 91(3): 565-578.
24. 吕少诚, 史宪杰, 梁雨荣, 等. 肝移植术后的早期肠内营养支持治疗: 附 86 例报告. 中华肝胆外科杂志, 2012, 18(9): 692-695.
25. 黄伟, 王毅, 谷斌斌, 等. 肝移植术后的营养支持治疗. 上海预防医学, 2013, 25(5): 269-271.
26. Binhas M, Amathieu R, Campillo B,et al. French survey on perioperative nutrition in cirrhotic adult patients waiting for liver transplantation. Ann Fr Anesth Reanim, 2013, 32(5): 302-306.
27. Oh PS, Fingeret AL, Shah MY,et al. Improved tolerance for enteral nutrition after serial transverse enteroplasty (STEP) in infants and children with short bowel syndrome–a seven-year single-center experience. J Pediatr Surg, 2014, 49(11): 1589-1592.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of perioperative nutritional support on protein metabolism and immunity in patients underwent liver transplantation

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