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Published on: November 7, 2020
Effect of orthotopic liver transplantation (OLT) on branched-chain amino acid requirement
Diana R Mager1, Linda J Wykes, Eve A Roberts
1Department of Nutritional Sciences, University of Toronto, The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada, M5G IX8.
Insights
Children after liver transplantation have increased branched-chain amino acid (BCAA) requirements. This study determined total BCAA needs in pediatric liver transplant recipients using indicator amino acid oxidation.
Area of Science:
- Pediatric Gastroenterology
- Transplant Nutrition
- Biochemistry
Background:
- Liver transplantation impacts nutrient metabolism, particularly amino acids.
- Branched-chain amino acid (BCAA) levels may remain altered post-transplant despite improved liver function.
- Understanding pediatric BCAA needs after liver transplant is crucial for nutritional management.
Purpose of the Study:
- To determine the total BCAA requirements in children following liver transplantation.
- To assess if BCAA metabolism normalizes after orthotopic liver transplantation (OLT).
Main Methods:
- Indicator amino acid oxidation (IAAO) method used in five pediatric liver transplant recipients.
- Tracer infusion of L-[1-13C] phenylalanine to measure 13CO2 oxidation.
- Graded intakes of total BCAA provided in egg protein proportions.
Main Results:
- The estimated average requirement for total BCAA was 172 mg/kg/d, with a 95% CI upper limit of 206 mg/kg/d.
- Total BCAA requirements in post-OLT children are higher than in healthy children.
- BCAA requirements are lower than in children with mild-moderate chronic cholestatic liver disease.
Conclusions:
- Pediatric liver transplant recipients have elevated total BCAA requirements post-transplant.
- Nutritional support should consider these increased BCAA needs.
- BCAA requirements are intermediate between healthy children and those with chronic liver disease.
Abstract:
Little is known regarding the impact of liver transplantation on amino acid requirements in children. Since plasma levels of the branched-chain amino acids (BCAA) are decreased in the presence of normal levels of the aromatic amino acids after liver transplantation, normalization of hepatic function may not fully correct changes in BCAA metabolism that occur in the pretransplant period. The goal of the present study was to determine total BCAA requirements of children following liver transplantation. The requirement of total BCAA was determined using indicator amino acid oxidation (IAAO) in five clinically stable children (5.7 +/- 3.5 y, mean +/- SD) 1-8 y post liver transplantation. Children received in random order 6 graded intakes of total BCAA. Individual BCAA in the test diet were provided in the same proportions as present in egg protein to minimize the potential interactive effects of individual BCAA on assessment of requirement. Total BCAA requirement was determined by measuring the oxidation of L-[1-13C] phenylalanine to 13CO2 [F13CO2 in micromol/kg/h], after a primed, continuous infusion of the tracer and using a two-phase linear regression crossover regression analysis. The estimated average requirement and the upper limit of the 95% CI for total BCAA in children who have undergone liver transplantation were 172 and 206 mg/kg/d), respectively. Total BCAA requirement in children who have undergone orthotopic liver transplantation (OLT) remain increased in the post-liver transplant period when compared with healthy school aged children, but is decreased when compared with children with mild-moderate chronic cholestatic (MCC) liver disease.
