Beneficial effects of supplementation with branched-chain amino acids on postoperative bacteremia in living donor liver transplant recipients

Abstract

The aim of this study was to investigate the effects of preoperative oral supplementation with branched-chain amino acids (BCAAs) on postoperative bacteremia after living donor liver transplantation (LDLT) for chronic liver failure. Two hundred thirty-six patients who underwent adult-to-adult LDLT were evaluated in this retrospective study. The patients were divided into 2 groups: those who received oral supplementation with BCAAs before transplantation (the BCAA group; n ¼ 129) and those who did not (the non-BCAA group; n ¼ 107). Before the LDLT indication was determined, BCAA supplementation was prescribed by a hepatologist to preserve hepatic reserves. The clinical characteristics and the incidence of bacteremia were compared between the 2 groups. As for clinical characteristics, the Child-Pugh scores (P ¼ 0.0003) and the Model for End-Stage Liver Disease scores (P ¼ 0.0008) were significantly higher in the BCAA group versus the non-BCAA group. The incidence of bacteremia for Child-Pugh class C patients was significantly lower in the BCAA group (6/90 or 6.7%) versus the non-BCAA group (11/50 or 22.0%, P ¼ 0.0132). In a multivariate analysis, non-BCAA supplementation was an independent risk factor for bacteremia. In conclusion, preoperative BCAA supplementation might reduce the incidence of bacteremia after LDLT. Nevertheless, this is a preliminary report, and further studies, such as randomized, prospective studies, are necessary to clarify the beneficial effects of BCAA supplementation on postoperative bacteremia after liver transplantation.

Branched-chain amino acids in liver diseases

“…Kawamura et al [99] reported that early interventional oral BCAAs might prolong the liver transplant waiting period by preserving hepatic reserve in patients with cirrhosis. A retrospective analysis also showed that BCAA treatment before LDLT may reduce the incidence of posttransplant bacteremia [100] .…”

Leucine and Citrulline: Two Major Regulators of Protein Turnover

“…In patients undergoing living donor liver transplantation, perioperative administration of the same BCAA-enriched mixture has been demonstrated to improve metabolic status [17] and reduce the incidence of bacteremia [18].…”

Feasible Isolated Liver Transplantation for a Cirrhotic Patient on Chronic Hemodialysis

“…The right lobe graft was procured using a typical method described elsewhere [1, 11, 12, 13, 14]. The actual graft weight was 546 g, which accounted for 50.4% of the recipient's standard liver volume.…”

“…The drained ascites was below 500 ml/day and all abdominal drains were removed by postoperative day 6 except for the biliary stents (table 1). Other than the renal replacement therapy and dose modulation of renal excretory drugs such as acyclovir, the perioperative management of the recipient was typical, as previously described [1, 11, 12, 13, 14]. Immunosuppression was induced with intravenous methylprednisolone and then switched to oral prednisolone, cyclosporin A and mycophenolate mofetil.…”