title: Pre- and postoperative immunonutrition in patients undergoing liver transplantation: a pilot study of safety and efficacy.
abstract: OBJECTIVE
  Malnutrition is common in patients with end-stage liver disease and is a risk factor for post-transplant morbidity. The goal of this study was to assess the safety of an immune-enhancing diet in patients undergoing liver transplantation and to investigate its effects on nutritional status.
  
  
  METHODS
  Fifteen consecutive patients received oral Impact (0.6l/d) for a median 54 (range 10-168)d pre-transplant and enteral Impact was started early after transplant. Total body protein was measured prior to commencing supplemental Impact, immediately prior to transplant and 10, 15, 30, 90, and 180 days post-transplant. The results were compared with those from 17 patients who received standard nutritional intervention.
  
  
  RESULTS
  All study patients tolerated Impact pre- and postoperatively and there were no safety concerns. Over the preoperative period total body protein increased significantly (P = 0.017). In 7 patients followed for 6 months post-transplant, a significant (P = 0.026) loss of body protein occurred over the first 15 postoperative days which was regained by 6 months. In the patients who did not receive Impact, body protein did not change preoperatively and the loss after surgery was not regained. Infectious complications occurred in 5/15 (33%) Impact patients and 12/17 (71%) non-Impact patients (P = 0.074).
  
  
  CONCLUSIONS
  In patients with end-stage liver disease, our results suggest the possibility that Impact may have a role in improving preoperative nutritional status, hastening recovery after transplant, and reducing postoperative infectious complications. These potential benefits need to be confirmed in a randomised controlled trial.
authors.affiliation: University Department of Surgery, Auckland Hospital, Fifth floor, Private Bag 92024, Park Road, Auckland 3, New Zealand. l.plank@auckland.ac.nz
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Plank
authors.forename: John L
authors.initials: JL
authors.lastname: McCall
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Gane
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rafique
authors.forename: Lynn K
authors.initials: LK
authors.lastname: Gillanders
authors.forename: Kerry
authors.initials: K
authors.lastname: McIlroy
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Munn
mesh_terms: D000328:Adult; D000368:Aged; D001798:Blood Proteins / Q000032:analysis* / Q000276:immunology / Q000378:metabolism; D001823:Body Composition; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000517:prevention & control* / Q000628:therapy; D008875:Middle Aged; D009752:Nutritional Status; D010865:Pilot Projects; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D012449:Safety; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001798:Blood Proteins