title: Impact of pretransplant nutritional status in patients undergoing liver transplantation.
abstract: OBJECTIVE
  Protein-energy malnutrition is common in patients with end-stage liver disease requiring liver transplantation and is a risk factor for posttransplant morbidity including sepsis. We therefore investigated the relationship between preoperative nutritional status and postoperative clinical course, and the risk factors for postoperative sepsis in patients undergoing living donor liver transplantation (LDLT), focusing on nutritional parameters.
  
  
  METHODS
  We preoperatively measured body cell mass (BCM) using a body composition analyzer and various nutritional parameters including prealbumin, branched-chain amino acids (BCAA)/tyrosine ratio, and zinc in 50 consecutive recipients undergoing LDLT between February 2008 and February 2009. Risk factors for post-transplant sepsis were analyzed.
  
  
  RESULTS
  The incidence of postoperative severe infection and in-hospital death was significantly higher in patients with preoperative low BCM than in patients with normal or high BCM. Multivariate predictors of posttransplant sepsis included preoperative low BCM (p = 0.016), absence of preoperative supplementation with BCAA-enriched nutrient mixture (p = 0.028), and a Model for End-stage Liver Disease score of 20 or above (p = 0.040).
  
  
  CONCLUSIONS
  Preoperative BCM level was closely related to the postoperative clinical course in patients undergoing LDLT. Pretransplant nutritional status and supplementation with BCAA-enriched nutrient mixture have potent impacts on the incidence of postoperative sepsis.
authors: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. kaido@kuhp.kyoto-u.ac.jp
authors: Toshimi
authors: T
authors: Kaido
authors: Akira
authors: A
authors: Mori
authors: Fumitaka
authors: F
authors: Oike
authors: Masaki
authors: M
authors: Mizumoto
authors: Yasuhiro
authors: Y
authors: Ogura
authors: Koichiro
authors: K
authors: Hata
authors: Atsushi
authors: A
authors: Yoshizawa
authors: Taku
authors: T
authors: Iida
authors: Shinji
authors: S
authors: Uemoto
mesh_terms: D000328:Adult; D000368:Aged; D001823:Body Composition; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality