title: Effects of Immunonutrition for Cystectomy on Immune Response and Infection Rates: A Pilot Randomized Controlled Clinical Trial.
abstract: After radical cystectomy (RC), patients are at risk for complications including infections. The expansion of myeloid-derived suppressor cells (MDSCs) after surgery may contribute to the lower resistance to infection. Immune response and postoperative complications were compared in men consuming either specialized immunonutrition (SIM; n=14) or an oral nutrition supplement (ONS; n=15) before and after RC. MDSC count (Lin- CD11b+ CD33+) was significantly different between the groups over time (p=0.005) and significantly lower in SIM 2 d after RC (p<0.001). MDSC count expansion from surgery to 2 d after RC showed a weak association with an increase in infection rate 90 d after surgery (p=0.061). Neutrophil:lymphocyte ratio was significantly lower in SIM compared with ONS 3h after the first incision (p=0.039). Participants receiving SIM had a 33% reduction in postoperative complication rate (95% confidence interval [CI], 1-64; p=0.060) and a 39% reduction in infection rate (95% CI, 8-70; p=0.027) during late-phase recovery. The small sample size limits the study findings.
  
  
  RESULTS
  Results show that the immune response to surgery and late infection rates differ between radical cystectomy patients receiving specialized immunonutrition versus oral nutrition supplement in the perioperative period.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01868087.
authors.affiliation: Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA; Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA. Electronic address: jhamilton-reeves@kumc.edu.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Hamilton-Reeves
authors.affiliation: Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Misty D
authors.initials: MD
authors.lastname: Bechtel
authors.affiliation: Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Hand
authors.affiliation: Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Schleper
authors.affiliation: Department of Microbiology, Molecular Genetics, and Immunology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Yankee
authors.affiliation: Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Prabhakar
authors.initials: P
authors.lastname: Chalise
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Lee
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Moben
authors.initials: M
authors.lastname: Mirza
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Hadley
authors.initials: H
authors.lastname: Wyre
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Griffin
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Holzbeierlein
mesh_terms: D000368:Aged; D039481:CD11b Antigen / Q000032:analysis; D049109:Cell Proliferation; D015653:Cystectomy / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005526:Food, Formulated / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D007615:Kansas; D008297:Male; D008875:Middle Aged; D022423:Myeloid Cells / Q000276:immunology*; D009752:Nutritional Status; D009753:Nutritive Value; D010641:Phenotype; D010865:Pilot Projects; D012307:Risk Factors; D063268:Sialic Acid Binding Ig-like Lectin 3 / Q000032:analysis; D013530:Surgical Wound Infection / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*
chemical_list: D039481:CD11b Antigen; C571163:CD33 protein, human; D063268:Sialic Acid Binding Ig-like Lectin 3
keywords: Arginine; Bladder cancer; Fish oil; Myeloid-derived suppressor cells; Neutrophil:lymphocyte ratio; PG-SGA; Radical cystectomy