Branched-chain amino acid-enriched nutrients improve nutritional and metabolic abnormalities in the early post-transplant period after living donor liver transplantation

J Hepatobiliary Pancreat Sci. 2012 Jul;19(4):438-48. doi: 10.1007/s00534-011-0459-5.


Background/purpose: Malnutrition and metabolic disorder of patients undergoing living donor liver transplantation (LDLT) can affect post-transplant prognosis. The aim of this study was to establish whether perioperative usage of branched-chain amino-acid (BCAA)-enriched nutrients improve metabolic abnormalities of patients undergoing LDLT.

Methods: We designed a randomized pilot study (UMIN registration number; 000004323). Twenty-five consecutive adult elective LDLT recipients were enroled and divided into two groups: the BCAA group (BCAA-enriched nutrients, n = 12) and the control group (standard diet, n = 13). Metabolic and nutritional parameters, including BCAA-to-tyrosine ratio (BTR), retinol binding protein (RBP), and prealbumin were regularly measured from 1 week before to 4 weeks after LDLT. Non-protein respiratory quotient (npRQ) was measured before and 4 weeks after LDLT.

Results: BTR and RBP improved considerably in the BCAA group compared with the controls. npRQ significantly increased from 1 week before LDLT to 4 weeks after LDLT in the BCAA group (0.77 ± 0.05 to 0.84 ± 0.06, P = 0.002), but not in the control group (0.78 ± 0.04 to 0.81 ± 0.05).

Conclusions: Supplementation with BCAA-enriched nutrients might improve persistent nutritional and metabolic disorders associated with end-stage liver disease in the early post-transplant period, and consequently shorten the post-transplant catabolic phase after LDLT. A larger multicenter trial is needed to confirm these findings.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Amino Acids, Branched-Chain / therapeutic use*
  • Calorimetry, Indirect
  • Dietary Supplements
  • Energy Metabolism
  • Enteral Nutrition
  • Female
  • Humans
  • Liver Diseases / metabolism*
  • Liver Diseases / therapy*
  • Liver Regeneration
  • Liver Transplantation
  • Living Donors
  • Male
  • Middle Aged
  • Nutritional Status
  • Pilot Projects
  • Postoperative Period
  • Prospective Studies


  • Amino Acids, Branched-Chain