Nutritional support for liver transplantation: identifying caloric and protein requirements.
OBJECTIVE
To characterize the caloric and protein requirements of patients with end-stage liver disease before and for 28 days after liver transplantation.


METHODS
We prospectively assessed 16 adult patients who were scheduled to undergo liver transplantation between December 1989 and September 1990.


METHODS
Nitrogen balance, 24-hour urinary creatinine, 3-methylhistidine, and resting energy expenditure were determined before transplantation and on days 1, 3, 5, 14, and 28 after transplantation. The investigators were unaware of the results of these measurements, and patients were fed in accordance with a previously established clinical protocol.


RESULTS
Resting energy expenditure did not increase from preoperative values; however, urinary nitrogen and 3-methylhistidine increased significantly after liver transplantation, an indication of protein catabolism from a myofibrillar source. A negative nitrogen balance persisted for 28 days post-operatively.


CONCLUSIONS
We recommend that caloric intake be determined by using the formulation provided by the Harris-Benedict equation at ideal body weight plus 20%. We also recommend that intake of protein be adjusted on the basis of preoperative nutritional assessment, perioperative hepatic and renal function, and results of tests used to measure the adequacy of administered protein. Parenterally or enterally administered protein of more than 1.2 g/kg daily should be well tolerated in most patients who have undergone liver transplantation.
Plevak
D J
DJ
Department of Anesthesiology, Mayo Clinic Rochester, MN 55905.
DiCecco
S R
SR
Wiesner
R H
RH
Porayko
M K
MK
Wahlstrom
H E
HE
Janzow
D J
DJ
Hammel
K D
KD
O'Keefe
S J
SJ
D000328:Adult; D000368:Aged; D001806:Blood Urea Nitrogen; D001835:Body Weight; D003404:Creatinine / Q000097:blood / Q000652:urine; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004734:Energy Metabolism; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000145:classification / Q000378:metabolism / Q000628:therapy* / Q000652:urine; D016031:Liver Transplantation; D008297:Male; D008762:Methylhistidines / Q000652:urine; D008875:Middle Aged; D009584:Nitrogen / Q000652:urine; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D010289:Parenteral Nutrition, Total / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies
D004044:Dietary Proteins; D008762:Methylhistidines; D003404:Creatinine; C028118:3-methylhistidine; D009584:Nitrogen