title: Peri-operative immunonutrition in patients undergoing liver transplantation: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  No consensus has been reached concerning the effects of peri-operative immunonutrition in patients undergoing liver transplantation. We conducted a meta-analysis to evaluate the effects of peri-operative immunonutrition on clinical outcomes and liver function in patients undergoing liver transplantation.
  
  
  METHODS
  The Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and google scholar were searched to identify all available randomized controlled studies which compared peri-operative immunonutrition support (glutamine, ω-3 polyunsaturated fatty acids, arginine and ribonucleic acids) with standard nutrition. The data analysis was performed using Revman 5.2 software.
  
  
  RESULTS
  A total of 7 randomized controlled trials (RCTs) involving 501 patients were included. Peri-operative immunonutrition significantly reduced the risk of infectious complications (RR: 0.51; 95% CI: 0.27 to 0.98, p=0.04) and shortened the postoperative hospital stay [weighted mean difference (WMD): -3.89; 95% CI: -7.42 to -0.36; p=0.03]. Furthermore, perioperative immunonutrition improved liver function by decreasing the levels of aspartate aminotransferase (AST) in the blood (WMD: -25.4; 95% CI: -39.9 to -10.9, p=0.0006). However, we did not find statistically significant differences in serum alanine aminotransferase (ALT), total bilirubin (TB) and direct bilirubin (DB) levels. There were no statistically significant differences in mortality and rejection reaction.
  
  
  CONCLUSIONS
  Peri-operative nutrition support adding immunonutrients like glutamine, ω-3 polyunsaturated fatty acids, arginine and ribonucleic acids may improve outcomes in patients undergoing liver transplantation. Due to the limited sample size of the included trials, further large-scale and rigorously designed RCTs are needed.
authors.affiliation: Department of General Surgery, Jinling Hospital, Clinical College of Southern Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Qiucheng
authors.initials: Q
authors.lastname: Lei
authors.affiliation: Department of General Surgery, Jinling Hospital, Clinical College of Southern Medical University, Nanjing, Jiangsu Province, China. Email: wxinying@263.net.|Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Xinying
authors.initials: X
authors.lastname: Wang
authors.affiliation: Key Laboratory for Medical Molecular Diagnostics of Guangdong Province, Guangdong Medical University, Dongguan, Guangdong Province, China.
authors.forename: Huazhen
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Jingcheng
authors.initials: J
authors.lastname: Bi
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Shanjun
authors.initials: S
authors.lastname: Tan
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
mesh_terms: D019587:Dietary Supplements; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007109:Immunity; D007239:Infections / Q000453:epidemiology; D007902:Length of Stay; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D044623:Nutrition Therapy; D009752:Nutritional Status; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome