| Background Patients with liver transplantation often have severe hepatic dysfunction preoperatively. The donor livers suffer from cold and warm ischemia and ischemia-reperfusion injury. So the abnormalities in nutrient metabolism in patients with liver transplantation are different from those with hepatic dysfunction only. Approprite nutritional support to these patients is essential. Until now, there are different opinions on the role of fat emulsion in patients after liver transplantation, which is due to lacking of sufficient scientific studies. It is unknown whether fat emulsion has side effects on liver function and metabolism in patients with liver transplantation. Also, there is no report about the metabolism and clearance of fat emulsion in transplanted livers. Objective To study the influence of glucose with different kinds of fat emulsions or without fat emulsion on liver function and metabolism in rats after liver transplantation and assess the feasibility and safety of TPN with fat emulsion after liver transplantation in rats.Material and methods A model of TPN in rats with liver transplantation with modified tube and retainer was established. 72 rats after liver transplantation were randomly divided into four groups according to the different energy sources. Rats in MCT/LCT group were given MCT/LCT and glucose; STG group were STG and glucose; LCT group were LCT and glucose; glucose was the only energy source in GLU group. All animals received isocaloric nutrients. All groups received isonitrogenous TPN supplemented with 1.5g mg of nitrogen per kilogram per day. Non-protein kilocalorie was provided as 741.8KJ per Kg of body weight, and the non-protein kilocalorie:nitrogen ratio was 494.5KJ:1g. TPN was maintained for 7 days. In three fat emulsion groups the ration of kilocalorie provided by glucose and fat emulsion was 6:4. The all-in-one nutrient solution was infused at the speed of 8.9ml/Kg·h in 24 hours. The specimen of blood, urine, and liver tissue were obtained on 1st, 4th, and 7th day after TPN.Changes of AKBR, ALT, AST, TBIL, TG, Tch, HDL-C, LDL-C, FFA, PL, LCAT, nitrogen balance, TG and Tch of liver, graft gained weight were determined and pathological changes of the liver was observed. Animal survival was recorded during the experimental period.Results1. Compared with other groups, serum ALT and AST levels in Group GLU were decreased slowly. While TBIL level was elevated gradually. Though AKBR was increased on 1st day after TPN , it declined gradually and was significantly lower than that in normal control group on 7th day. Serum HDL-C, FFA, and PL were significantly decreased, while serum levels of TG and LDL was elevated. Positive nitrogen balance could not be maintained. Continuous liver edema was found in rats with GLU TPN during the experiment period. Furthermore, severe disorganization of liver, for example: hepatocyte necrosis, cholestasis, mitochondria swelling, and rough endoplasmic reticulum dilataltion was observed in this group. Mortality rate of rats in GLU group was 50% on 7th day.2 In the three fat emulsions groups, the serum ALT, AST, TBIL and AKBR recovered to normal level 7 days after TPN. The level of TG, Tch, LDL-C, PL, LCAT were at normal level at the end of the experiment, while HDL-C and FFA were elevated significantly. Positive nitrogen balance was achieved in all groups on 7th day. Liver edema was observed on 1st day after TPN, but disappeared gradually. The main pathological change of hepatocytes was swelling during the early period of TPN, but the hepatocytes became normal in morphology on 7th day, and hepatic lobule was integral. No animal death due to TPN was found in fat emulsion groups.3 Serum levels of ALT and AST in Group STG were more significantly lower than those in Group MCT/LCT, and ALT and AST in Group MCT/LCT were significantly decreased when compared with Group LCT, especially during the early period of TPN. The changes of nitrogen balance were the same as those of ALT and AST. Positive nitrogen balance was achieved firstly i...
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