Publication

Abstract : Introduction: It is pertinent to study the effect of perioperative immunonutrition (IMN) supplementation in adult patients undergoing living donor liver transplantation (LDLT). Materials and Methods: A randomised controlled pilot trial was conducted in 20 patients admitted at Amrita Institute of Medical Sciences, Kochi, between November 2018 and January 2019. By means of computer-generated random numbers, 20 patients were allocated to IMN (Pentasure Immunomax® containing omega-3 fatty acids, L-arginine and ribonucleic acid salts) or control (CON; Accumax Advance® which is a standard protein supplement) group in 1:1 ratio. The supplements were provided from pre-operative day 7 and restarted postoperatively as soon as oral intake was resumed for 2 weeks. The primary endpoint was the length of intensive care unit (ICU) and hospital stay. The secondary endpoints included anthropometric measurements (triceps skinfold thickness [TST], mid-upper arm circumference and weight measured on pre-operative day 1 and post-operative day [POD] 30), biochemical parameters (liver function test assessed on pre-operative day 1 and POD 9) and infectious complications. Results: Significant improvement in TST from pre-operative day 1 to POD 30 was seen in the IMN group (7.45 ± 5.45–9.20 ± 6.12, P = 0.049) but not in the CON group (5.40 ± 2.27–5.00 ± 3.02, P = 0.438). Weight loss percentage was also lower in IMN in comparison to CON (10.09 ± 6.01 vs. 15.56 ± 4.39, P = 0.050). However, the length of ICU and hospital stay, biochemical parameters and rate of infection were statistically similar in both the groups. Conclusion: In patients undergoing LDLT, perioperative IMN supplementation provided enhancement in the anthropometrical parameters, although this did not translate into lesser hospital or ICU stay. A larger sample size will help in providing more insight into the beneficial effects of the IMN supplementation.