EARLY ENTERAL NUTRITION SUPPORT IN PATIENTS UNDERGOING LIVER-TRANSPLANTATION

Background: The purpose of this study was to determine the effects of early postoperative tube feeding on outcomes of liver transplant recip ients. Methods: Fifty transplant patients were randomized prospectivel y to receive enteral formula via nasointestinal feeding tubes (tube-fe eding [TF] group) or maintenance TV fluid until oral diets were initia ted (control group). Thirty-one patients completed the study. Resting energy expenditure, nitrogen balance, and grip strength were measured on days 2, 4, 7, and 12 after liver transplantation. Calorie and prote in intakes were calculated for 12 days posttransplant. Results: Tube f eeding was tolerated in the TF group (n = 14). The TF patients had gre ater cumulative 12-day nutrient intakes (22,464 +/- 3554 kcal, 927 +/- 122 g protein) than did the control patients (15,474 +/- 5265 kcal, 6 37 +/- 248 g protein) (P < .002). Nitrogen balance was better in the T F group on posttransplant day 4 than in the control group (P < .03). T here was a rise in the overall mean resting energy expenditure in the first two posttransplant weeks from 1487 +/- 338 to 1990 +/- 367 kcal (P = .0002). Viral infections occurred in 11.7% of control patients co mpared with 0% of TF patients (P = .05). Although other infections ten ded to occur more frequently in the control group us the TF group (bac terial, 29.4% us 14.3%; overall infections, 47.1% vs 21.4%), these dif ferences were not statistically significant. Early posttransplant tube feeding did not influence hospitalization costs, hours on the ventila tor, lengths of stay in the intensive care unit and hospital, rehospit alizations, or rejection during the first 21 posttransplant days. Conc lusions: Early posttransplant tube feeding was tolerated and promoted improvements in some outcomes and should be considered for all liver t ransplant patients.