title: Recovery of nutritional metabolism after liver transplantation.
abstract: OBJECTIVE
  Perioperative nutritional assessment is critically important to reflect nutritional management because liver transplantation (LTx) often is undertaken in patients with poor nutritional status. The aim of this study was to evaluate nutritional status, including the non-protein respiratory quotient (npRQ), resting energy expenditure (REE), nitrogen balance, and blood biochemical parameters in patients before and after LTx.
  
  
  METHODS
  Fourteen patients undergoing LTx and 10 healthy controls were enrolled in this study. The npRQ and REE were measured using indirect calorimetry before LTx and at 2, 3, and 4 wk after the procedure. Blood biochemistry and nitrogen balance calculated by 24-h urine collection were performed concurrently with indirect calorimetric measurement; the results were compared between the two groups.
  
  
  RESULTS
  Before LTx, npRQ was significantly lower and serum non-esterified fatty acid levels were significantly higher in the patients than in the controls. Furthermore, a negative nitrogen balance was observed in the patients. These, however, improved significantly at 4 wk after LTx. REE did not significantly increase compared with the preoperative values in recipients. Blood biochemistry showed gradually increasing levels of serum cholinesterase and albumin. These failed to reach to normal levels by 4 wk post-transplant.
  
  
  CONCLUSIONS
  The findings revealed that improvement of nutritional metabolism after LTx may require 4 wk. Additional nutritional strategies, therefore, may be needed to minimize catabolic state during the early post-transplant period. Adequate, individualized nutritional guidance before and after LTx should be performed in these patients.
authors.affiliation: Departments of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Sugihara
authors.affiliation: Departments of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan. Electronic address: yamanaka@nutr.med.tokushima-u.ac.jp.
authors.forename: Hisami
authors.initials: H
authors.lastname: Yamanaka-Okumura
authors.affiliation: Departments of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Arisa
authors.initials: A
authors.lastname: Teramoto
authors.affiliation: Departments of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Eri
authors.initials: E
authors.lastname: Urano
authors.affiliation: Department of Statistics and Computer Science, College of Nursing Art and Science, University of Hyogo, Hyogo, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Katayama
authors.affiliation: Departments of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morine
authors.affiliation: Departments of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Imura
authors.affiliation: Departments of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Utsunomiya
authors.affiliation: Departments of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.affiliation: Departments of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Takeda
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D002153:Calorimetry, Indirect; D016022:Case-Control Studies; D002802:Cholinesterases / Q000097:blood; D004734:Energy Metabolism; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000097:blood; D015596:Nutrition Assessment; D009752:Nutritional Status; D019990:Perioperative Care; D012709:Serum Albumin
chemical_list: D005230:Fatty Acids, Nonesterified; D012709:Serum Albumin; D002802:Cholinesterases; D009584:Nitrogen
keywords: Liver transplantation; Nitrogen balance; Non-esterified fatty acid; Non-protein respiratory quotient; Small and frequent meals