[Management of nutritional support and stress hyperglycemia after orthotopic liver transplantation]

To study the influence of different nutritional regimes on the stress hyperglycemia and the outcome after orthotopic liver transplantation, for the purpose of optimizing nutritional regime for early post-operative period.

One hundred and seventy-two patients who received liver transplantation for chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) induced hepatic function failure or end-stage cirrhosis were enrolled, and the post-operative complications and length of stay in intensive care unit (ICU) were retrospectively analyzed, in regard to high caloric (HC) or low caloric (LC) nutritional regime with their blood glucose controlled to a optimal level.

After the liver transplantation, those patients who were supplied with LC (83.7-104.6 kJ.kg(-1).d(-1)), energized stepwise with higher fat ratio (sugar:fat=50%:35%) with blood glucose being maintained <8 mmol/L, had less exogenous insulin requirement (P<0.01), lower infection-related mortality rate (P<0.05), and shortened weaning from mechanical ventilation time and length of stay in ICU (both P<0.05), compared with those who were supplied with HC nutrition (125.5-146.4 kJ.kg(-1).d(-1)) with routine sugar and fat ratio (55%:35%), and blood glucose maintained at the same level. However, there was no significant differences in serum bilirubin contents, incidences of poor healing of incision and anastomosis as well as hypoglycemia, and extrinsic albumin requirement between two groups.

LC nutrition regime and controlling the blood glucose <8 mmol/L during the early post-operative period may reduce the incidence of post-operative complications without influencing the prognosis.