Comparative study of the safety and efficacy of SMOFlipid vs non SMOFlipid as TPN for liver transplantation

Mei-Yun Wu; Sheng-Chih Kuo; Su-Fen Chuang; Cheng-Hsi Yeh; Shih-Min Yin; Wei-Feng Li; Hung-Jen Wang; Chao-Long Chen; Chih-Chi Wang; Chih-Che Lin

doi:10.1016/j.amsu.2021.01.042

Comparative study of the safety and efficacy of SMOFlipid vs non SMOFlipid as TPN for liver transplantation

Ann Med Surg (Lond). 2021 Feb 18:63:102094. doi: 10.1016/j.amsu.2021.01.042. eCollection 2021 Mar.

Authors

Mei-Yun Wu^{1

2}, Sheng-Chih Kuo³, Su-Fen Chuang⁴, Cheng-Hsi Yeh³, Shih-Min Yin³, Wei-Feng Li³, Hung-Jen Wang⁵, Chao-Long Chen³, Chih-Chi Wang³, Chih-Che Lin³

Affiliations

¹ College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Department of Nursing, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
³ Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁴ Dietitian, Department of Nutritional, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁵ Department of Urology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

Abstract

Background: 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.

Materials and methods: The medical records of 54 recipients of living donor LT between January 2012 and June 2015 were retrospectively reviewed. Patients with pretransplant platelet count <40,000/μL and >40,000/μL were assigned to the non-SMOFlipid (n = 23) group and the SMOFlipid (n = 31) group, respectively.

Results: The coagulation and nutrition profile of patients improved significantly after TPN support. No significant difference was observed in the coagulation profile between SMOFlipid and non-SMOFlipid groups. Although the SMOFlipid group exhibited a higher platelet count than the non-SMOFlipid group on day 7 (P < 0.001), no significant differences were observed in the platelet count on 14 and 30 days after TPN support between the 2 groups.

Conclusion: TPN using SMOFlipid after LT is a good strategy for improving nutritional status without increasing the risks of bleeding and coagulation in patients intolerant of early enteral nutrition. Moreover, SMOFlipid use may not cause coagulopathy up to 14 days after LT. Overall, SMOFlipid provides nutritional benefits without increasing the risk of bleeding.

Keywords: Fish oil; Liver transplantation; SMOFlipid.