title: A randomized pilot trial of oral branched-chain amino acids in early cirrhosis: validation using prognostic markers for pre-liver transplant status.
abstract: Because of the chronic shortage of liver donors, hepatologists are required to prolong the liver transplant waiting period by preserving the hepatic reserve of scheduled recipients. This study examined the effectiveness of oral branched-chain amino acids (BCAAs), using outcome markers indicating pretransplant hepatic reserve. Fifty-six consecutive eligible patients with Child class A cirrhosis without major complications were randomly assigned to receive oral BCAA granules (12.45 g/day) for least 1 year or no BCAAs. Differences between groups in the Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, asialoscintigraphic clearance index (CI), and complications were examined. Of 50 remaining patients, 27 received BCAAs, and 23 received no BCAAs (mean duration, 3.2 years). The mean annual changes in the MELD score, CTP score, and asialoscintigraphic CI were smaller in the BCAA group than in the control group (-0.06 +/- 0.23 versus 0.10 +/- 0.40, P = 0.024, 0.06 +/- 0.30 versus 0.30 +/- 0.48, P = 0.037, and 0.00 +/- 0.02 versus 0.02 +/- 0.04, P = 0.040, respectively). The mean annual changes in the serum total bilirubin and the serum albumin in the BCAA group were better preserved than those in the control group (-0.07 +/- 0.20 versus 0.12 +/- 0.18 mg/dL, P < 0.001, and 0.07 +/- 0.13 versus -0.02 +/- 0.19 g/dL, P = 0.005, respectively); other laboratory variables were not significant. The incidence of overall major cirrhotic complications was lower in the BCAA group than in the control group [14.8% (4 of 27 patients) versus 30.4% (7 of 23 patients) at 3 years, P = 0.043]; only ascites was significant individually. In conclusion, early interventional oral BCAAs might prolong the liver transplant waiting period by preserving hepatic reserve in cirrhosis.
authors: Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan. etsushi-k@med.osaka-cu.ac.jp
authors: Etsushi
authors: E
authors: Kawamura
authors: Daiki
authors: D
authors: Habu
authors: Hiroyasu
authors: H
authors: Morikawa
authors: Masaru
authors: M
authors: Enomoto
authors: Joji
authors: J
authors: Kawabe
authors: Akihiro
authors: A
authors: Tamori
authors: Hiroki
authors: H
authors: Sakaguchi
authors: Shigeru
authors: S
authors: Saeki
authors: Norifumi
authors: N
authors: Kawada
authors: Susumu
authors: S
authors: Shiomi
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage* / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D000597:Amino Acids, Branched-Chain; D015415:Biomarkers