NUTRITIONAL SUPPORT FOR LIVER-TRANSPLANTATION - IDENTIFYING CALORIC AND PROTEIN-REQUIREMENTS

Objective: To characterize the caloric and protein requirements of pat ients with end-stage liver disease before and for 28 days after liver transplantation.Design: We prospectively assessed 16 adult patients wh o were scheduled to undergo liver transplantation between December 198 9 and September 1990. Material and Methods: Nitrogen balance, 24-hour urinary creatinine, 3-methylhistidine, and resting energy expenditure were determined before transplantation and on days 1, 3, 5, 14, and 28 after transplantation, The investigators were unaware of the results of these measurements, and patients were fed in accordance with a prev iously established clinical protocol. Results: Resting energy expendit ure did not increase from preoperative values; however, urinary nitrog en and 3-methylhistidine increased significantly after liver transplan tation, an indication of protein catabolism from a myofibrillar source . A negative nitrogen balance persisted for 28 days postoperatively. C onclusion: We recommend that caloric intake be determined by using the formulation provided by the Harris-Benedict equation at ideal body we ight plus 20%. We also recommend that intake of protein be adjusted on the basis of preoperative nutritional assessment, perioperative hepat ic and renal function, and results of tests used to measure the adequa cy of administered protein, Parenterally or enterally administered pro tein of more than 1.2 g/kg daily should be well tolerated in most pati ents who have undergone liver transplantation.