engleski

Protein metabolism in patients after organ transplantation

INTRODUCTION: During last decades organ transplantation has evolved into a proven therapy for end-stage organ failure. However, the long-term success of organ transplantation depends significantly on patients' ability to overcome possible postoperative complications and to recover from a severe metabolic misbalance. The aim of our study was to compare early post-operative protein intake through parenteral nutrition with main biochemical parameters of protein catabolism. METHODS: 60 patients were included in the study, 50 with liver transplantation, 8 with kidney transplantation, and two patients with both, liver and kidney transplantation. Throughout the stay in an intensive care unit, patients' total nutritional intake was monitored. Blood samples were collected from day 0 (before liver transplantation), on day 1 and day 3 after transplantation. In serum concentrations of urea and creatinine, as well as catalytic concentrations of AST, ALT, AP and GGT were measured with IFCC recommended methods in the Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Merkur, accredited according to ISO 15 189 standard. RESULTS: In liver transplants, urea concentration increased 24 hours after transplantation, with trend to normalization after 3 days, while creatinine concentration did not change significantly. In kidney transplants, concentration of both, urea and creatinine, was high above reference values before transplantation. After transplantation, urea was significantly reduced, but high creatinine values persisted. Catalytic concentrations of the monitored enzymes were high, especially for liver transplants. Energy intake through parenteral nutrition was supplied mainly by glucose, with low amounts of proteins, i.e. amino acids. CONCLUSION: For liver transplant recipients, primary risk factors include post-transplant acute renal failure, while metabolic status is characterized by a significant malnutrition. Intensive catabolism, especially of proteins, requires appropriate nutritional support through formulas for total parenteral nutrition.

kidney; liver; parenteral nutrition; protein; transplantation

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