| Background and Objectives:Patients with liver transplantation (LT) often have severe hepatic dysfunction preoperatively. The donor livers suffer from cold and warm ischemia and ischemia-reperfusion injury. Thus the metabolism in patients with LT is different from those with hepatic dysfunction merely. Appropriate nutritional support for these patients is essential but still not fully elucidated. Until now, there are different opinions on the role of fat emulsion in LT recipients. Based on the facts that TPN with monosaccharide as the energy substrate makes liver function and metabolism deteriorate while TPN with energy supplied with glucose and different kinds of fat emulsion possesses safety and efficacy in LT rats, we observed prospectively the effect of TPN containing fat emulsion administration on graft function and metabolism in early stage of LT postoperatively, and evaluated its safety and feasibility with the aim to provide appropriate information on nutritional support in patients with liver transplantation.Materials and Methods:A total of thirty LT recipients between Sep 2001 and June 2004 in Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University were randomizedly and double-blindedly classified into two groups according to different energy resource, namely Glucose and Glucose+20% Intralipid group. All subjects received equal nitrogen and equal calorice. Non-protein kilocalorie of 20-25kcal·kg-1·d-1 and nitrogen of 0.15-0.20g·kg-1·d-1 were provided, and the non-protein kilocalorie:nitrogen ratio was 120-150:1 with energy ratio 2:1. The all-in-one nutrient solution was infused at the speed less than 0.1g·kg-1·d-1 in 24 hours. The specimens of blood, urine, and liver tissue were collected at different time points preoperatively and postoperatively. Changes of ALT, AST, ALP, GGT, TBIL, DBIL, TG, Tch, HDL-C, APO-A, APO-B, nitrogen balance were determined and pathological changes of the liver were observed. Moreover, survival wererecorded during the experimental period. Results:1. No death related to TPN was observed. However, two recipients from Glucose group died of encephaledema and fungal infection respectively during the 180d observation period.2. Serum ALT, AST, TBIL and DBIL levels in Glucose group decreased slower. TG and APO-A increased slowly while LDL-C, APO-B and HDL-C decreased. Negative nitrogen balance was apparent within lOd after LT and positive nitrogen balance was achieved late on 14th day. Furthermore, such severe disorganization of liver tissue as hepatocyte ballooning degeneration, cholestasis and inflammatory cells infiltration were observed microscopically within 7d. However, in Glucose+20% Intralipid group, serum ALT, AST, TBIL and DBIL decreased rapidly, and ALP, GGT presented a decreasing tendency. Within lOd, serum TG decreased significantly and draw near to preoperative level, while LDL-C,APO-B and HDL-C,APO-A decreased or increased respectively with the result that positive nitrogen balance nearly recovered on 10th day and the value of nitrogen balance was much higher than that in Glucose group. At the early stage of TPN, hepatocyte swelling was the main manifestation of pathological changes, however, normal integrity of hepatic lobules restored on 7th day.Conclusions:1. TPN with kilocalorie provided only by glucose in early stage of LT postoperatively would worsen not only the impairment of liver tissue and function but also the imbalance of nutrient metabolism.2. On the other hand, TPN containing fat emulsion would facilitate the recovery of liver tissue and function, correct nutritional metabolism disorder and restore positive nitrogen balance. In a word, TPN containing glucose and fat emulsion, providing non-protein kilocalorie of 20-25kcal-kg"1-d'1 with energy ratio 2:1 and infused at the speed of less than O.lg-kg'-d"1 in 24 hours, is safe and effective, and helpful for liver function improvement and recovery of metabolism in liver transplantation recipients. |
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