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

Video：

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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.	?鄭樹森. 肝臟移植. 北京: 人民衛生出版社, 2001: 251-252.
2.	周旭, 劉軍, 楊鳳輝, 等. 不同脂肪組分營養支持影響肝移植病人蛋白質代謝的臨床研究. 中國實用外科雜志, 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.	史長城, 林東海, 翁哮華, 等. 肝移植術后營養支持的研究進展. 腸外與腸內營養, 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.	黎介壽. 腸內營養——外科臨床營養支持的首選途徑. 中國實用外科雜志, 2003, 23(2): 67-69.
10.	Horster S, B?uerlein 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.	朱曉丹, 沈中陽, 臧運金, 等. 肝移植后膽道鑄型 4 例全蛋白質的表達. 中國組織工程研究與臨床康復, 2010, 14(18): 3401-3404.
17.	易波, 葉啟發, 成科, 等. 腎移植術后重癥肺部感染病人營養支持對免疫功能影響的臨床研究. 中國現代醫學雜志, 2009, 19(7): 1078-1080.
18.	江濤, 王軒, 張斌, 等. 谷氨酰胺聯合生長激素在肝移植病人術后應用的臨床研究. 腸外與腸內營養, 2011, 18(2): 71-74.
19.	陽文新, 鐘正江, 曹耀軍, 等. 早期腸內營養支持在肝癌患者肝移植術后的應用. 臨床腫瘤學雜志, 2009, 14(9): 827-830.
20.	施曉雷, 任昊楨, 吳亞夫, 等. 腸外聯合腸內營養支持在肝功能衰竭病人肝移植術后的應用. 腸外與腸內營養, 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. 重視肝移植術后早期腸內營養支持// 中華醫學會腸外腸內營養學分會第八屆全國腸外腸內營養學術大會論文集, 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.	呂少誠, 史憲杰, 梁雨榮, 等. 肝移植術后的早期腸內營養支持治療: 附 86 例報告. 中華肝膽外科雜志, 2012, 18(9): 692-695.
25.	黃偉, 王毅, 谷斌斌, 等. 肝移植術后的營養支持治療. 上海預防醫學, 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. ?鄭樹森. 肝臟移植. 北京: 人民衛生出版社, 2001: 251-252.
2. 周旭, 劉軍, 楊鳳輝, 等. 不同脂肪組分營養支持影響肝移植病人蛋白質代謝的臨床研究. 中國實用外科雜志, 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. 史長城, 林東海, 翁哮華, 等. 肝移植術后營養支持的研究進展. 腸外與腸內營養, 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. 黎介壽. 腸內營養——外科臨床營養支持的首選途徑. 中國實用外科雜志, 2003, 23(2): 67-69.
10. Horster S, B?uerlein 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. 朱曉丹, 沈中陽, 臧運金, 等. 肝移植后膽道鑄型 4 例全蛋白質的表達. 中國組織工程研究與臨床康復, 2010, 14(18): 3401-3404.
17. 易波, 葉啟發, 成科, 等. 腎移植術后重癥肺部感染病人營養支持對免疫功能影響的臨床研究. 中國現代醫學雜志, 2009, 19(7): 1078-1080.
18. 江濤, 王軒, 張斌, 等. 谷氨酰胺聯合生長激素在肝移植病人術后應用的臨床研究. 腸外與腸內營養, 2011, 18(2): 71-74.
19. 陽文新, 鐘正江, 曹耀軍, 等. 早期腸內營養支持在肝癌患者肝移植術后的應用. 臨床腫瘤學雜志, 2009, 14(9): 827-830.
20. 施曉雷, 任昊楨, 吳亞夫, 等. 腸外聯合腸內營養支持在肝功能衰竭病人肝移植術后的應用. 腸外與腸內營養, 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. 重視肝移植術后早期腸內營養支持// 中華醫學會腸外腸內營養學分會第八屆全國腸外腸內營養學術大會論文集, 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. 呂少誠, 史憲杰, 梁雨榮, 等. 肝移植術后的早期腸內營養支持治療: 附 86 例報告. 中華肝膽外科雜志, 2012, 18(9): 692-695.
25. 黃偉, 王毅, 谷斌斌, 等. 肝移植術后的營養支持治療. 上海預防醫學, 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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