Liver Transplantation Clinical Trial
Official title:
Supplements SMOF in TPN for Liver Transplantation Recipients
Liver transplantation (LT) is one of the widely recognised and leading treatments for end-stage liver disease. Nutrition impacts its success. Total parenteral nutrition (TPN) is usually prescribed for patients recommended prolonged fasting after LT. The supplement of SMOFlipid (soybean oil, MCT oil, olive oil, and fish oil) is easily metabolised to produce energy, and it possesses anti-inflammatory effects; however, SMOFlipid emulsion use raises concerns regarding coagulopathy after LT. This study investigated the postoperative correlation between SMOFlipid and coagulation in LT.
Liver failure is characterised by the loss of liver function and is complicated with hepatic
encephalopathy and coagulopathy. Liver transplantation (LT) is one of the widely recognised
and leading treatments for end-stage liver disease. Malnutrition is one of the common
manifestations of this critical condition and is also an independent predictor of mortality.
Several studies have shown that malnutrition is a poor prognostic factor for LT, which
indicates that nutritional support may reduce LT complications and improve survival.
Total parenteral nutrition (TPN) is usually prescribed for patients recommended prolonged
fasting after LT. The supplement of SMOFlipid (soybean oil, MCT oil, olive oil, and fish oil)
has the advantage of being easily metabolised to produce energy, and it has anti-inflammatory
effects. The major therapeutic mechanism of fish oil is the attenuation of systematic
inflammation, which may decrease the mortality risk in patients with severe injury and
sepsis. SMOFlipid has been proven to be safe and well tolerated in a wide range of clinical
conditions, and it is used as the standard lipid emulsion. Moreover, the short-term
application of parenteral fish oil with soybean oil not only significantly reduces the
parameters of liver damage in the postoperative period but also leads to a more balanced
immune response, which may result in the faster resolution of inflammation and recovery.
However, SMOFlipid emulsion use may be associated with coagulopathy after LT. Early studies
have shown that the dietary intake of n-3 fatty acids, which is a component of fat, is
associated with antithrombotic effects but increases the risk of bleeding. A detailed
analysis is lacking, and these observations have yet to be proven; this concern persists.
Hence, the investigators should pay attention to the bleeding tendency when using fish oil
fat emulsion because it may aggravate the risk of bleeding. Therefore, the use of fish
oil-containing fat emulsion and its related risks is a clinically important issue in early LT
that should be investigated, because liver function is not restored immediately after
transplantation, and there is a tendency of coagulopathy. Thus, classical haemostasis
parameters such as activated partial thromboplastin time (aPTT) and platelet count are
measured prior to surgery and before the start of TPN. However, many questions remain
unanswered regarding nutritional assessment and support for these seriously ill,
nutritionally, and metabolically complex patients. This study evaluated the effect of the
SMOFlipid supplement in TPN in LT patients.
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