Sequential Changes in the Metabolic Response to Orthotopic Liver Transplantation During the First Year After Surgery

Abstract

ObjectiveTo quantify the sequential changes in the metabolic response occurring in patients with end-stage liver disease after orthotopic liver transplantation (OLT). Summary Background DataDetailed quantification of the changes in energy expenditure, body composition, and physiologic function that occur in patients after OLT has not been performed. Understanding these changes is essential for the optimal management of these patients. MethodsFourteen patients who underwent OLT for end-stage liver disease had measurements of resting energy expenditure, body composition, and physiologic function immediately before surgery and 5, 10,15,30, 90, 180, and 360 days later. ResultsResting energy expenditure was significantly elevated after surgery (24% above predicted), peaking around day 10 after OLT, when it averaged 42% above predicted. A significant degree of hypermetabolism was still present at 6 months, but at 12 months measured resting energy expenditure was close to predicted values. Before surgery, measured total body protein was 82% of estimated preillness total body protein. During the first 10 days after OLT, a further 1.0 kg (10%) of total body protein was lost, mostly from skeletal muscle. Only 54% of this loss was restored by 12 months. Significant overhydration of the fat-free body was seen before OLT, and it was still present 12 months later. Although significant losses of body fat and bone mineral occurred during the early postoperative period, only body fat stores were restored at 12 months. Both subjective fatigue score and voluntary hand grip strength improved rapidly after OLT to exceed preoperative levels at 3 months. At 12 months grip strength was close to values predicted for these patients when well. Respiratory muscle strength improved less markedly and was significantly lower than predicted normal levels at 12 months. ConclusionsBefore surgery, these patients were significantly protein-depleted, overhydrated, and hypermetabolic. After surgery, the period of hypermetabolism was prolonged, restoration of body protein stores was gradual and incomplete, and respiratory muscle strength failed to reach expected normal values. Our measurements indicate that OLT does not normalize body composition and function and imply that a continuing metabolic stress persists for at least 12 months after surgery.Orthotopic liver transplantation (OLT) is the accepted treatment for patients with end-stage liver disease. The surgical death rate for this procedure has decreased progressively during the past decade as a result of improvements in surgical technique, anesthesia, and postoperative care. Overall 1-year graft and patient survival rates of 80% to 90% can now be expected. For elective patients with nonrecurrent disease, the 1-year survival rate exceeds 90%.

Anti-fatigue Effect of Ginsenoside Rb1 on Postoperative Fatigue Syndrome Induced by Major Small Intestinal Resection in Rat

“…[15][16][17] Biological, psychological and social factors are responsible for the development and progression of POFS.…”

“…14) Much of the published research suggests that POFS is an endocrine-metabolic response to surgical stress. [15][16][17] Biological, psychological and social factors are responsible for the development and progression of POFS. 18) Due to its unclear etiology, there are few effective interventions for POFS.…”

Nutritional Status and Liver Transplantation

“…In a small group of 14 unselected patients, the resting energy expenditure increased significantly (42% above the predicted values) during the first 10 days, and a significant degree of hypermetabolism was still present 6 months after LT while, after 12 months, the measured resting energy expenditure was completely normalized. 66 Using sophisticated techniques to estimate body composition, these authors also showed a loss of the total body fat during the early postoperative period which was fully regained at 3 months while a depletion in the skeletal muscle protein was still recognizable after 12 months. A retrospective study by Richards et al 67 suggested that a progressive weight gain is expected in all the patients after LT.…”

Establishment and assessments of a new model for the postoperative fatigue syndrome by major small intestinal resection in rats

“…Multiple reports have demonstrated that POFS is a stress-endocrine hypermetabolic reaction following surgical interventions [7][8][9]. In addition, a specific brain-gut axis may be involved in the postoperative gastrointestinal tract function.…”