الفهرس 
Perioperative ChangesinNutritional Parameters andImpactofGraftSizeinPatients Undergoing AdultLivingDonorLiver TransplantationOnly 14 pages are availabe for public view
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Abstract
Derangements of various serum biochemical nutritional/metabolic parameters are common in patients with end-stage liver disease who undergo liver transplantation. The aim of this study was to explain the benefit of liver transplantation with respect to parameter changes and to examine the impact of graft weight to recipient body weight ratio on such changes. We investigated each parameter’s course in 208 adult recipients for one year after living donor liver transplantation and sub-analyzed changes in the parameters using a graft weight-to-recipient body weight ratio of 0.8% as the cutoff point. Bonferroni corrections were applied to account for multiple testing.Liver disease-induced high pre-transplant ammonia, tyrosine, low branched-chain-amino-acids-to-tyrosine-ratio and zinc normalized within two weeks after transplantation, and total lymphocyte count normalized in two months, while low pre-transplant prealbumin took one year to normalize. Branched-chain-amino-acids, zinc and total lymphocyte count transiently dropped shortly after transplantation, then corrected later on. An accelerated recovery of ammonia and tyrosine levels and the branched-chain-amino-acids-to-tyrosine-ratio was found with larger-sized grafts, especially early after transplantation, while, zinc, prealbumin, branched-chain amino acids and total lymphocyte count recovered irrespective of graft size. Moreove,preoperative skeletal muscle mass and nutritional/metabolic parameter levels were compared in 129 patients undergoing adult-to-adult living donor liver transplantation whether received branched-chain-aminoacids treatment before admission or not. Pre-albumin and branched-chain-amino-acids-to-tyrosine ratio were significantly higher while tyrosine was lower in branched-chain-amino-acids-pre-supplemented than non-pre-supplemented group, while skeletal muscle mass, total lymphocyte count, zinc, branched-chain-amino-acids and ammonia levels were not significantly different. Multivariate predictors of post-transplant bacteremia were: Child-Pugh class C (P=0.012), low preoperative total lymphocyte count (P=0.027), operative blood loss ≥ 10 L (P=0.039) and absence of pre-admission branched-chainamino- acids treatment(P=0.040). In conclusion, pre-admission branched-chain-amino-acid therapy could ameliorate preoperative amino acid imbalance and the incidence of post-transplantbacteremia. Graft size had little impact on the recovery of nutritional/metabolic parameters except ammonia and tyrosine levels.