Peri-operative immunonutrition in patients undergoing liver transplantation: a meta-analysis of randomized controlled trials.

No consensus has been reached concerning the effects of peri-operative immunonutrition in patients undergoing liver transplantation. We conducted a meta-analysis to evaluate the effects of peri-operative immunonutrition on clinical outcomes and liver function in patients undergoing liver transplantation.The Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and google scholar were searched to identify all available randomized controlled studies which compared peri-operative immunonutrition support (glutamine, ω-3 polyunsaturated fatty acids, arginine and ribonucleic acids) with standard nutrition. The data analysis was performed using Revman 5.2 software.A total of 7 randomized controlled trials (RCTs) involving 501 patients were included. Peri-operative immunonutrition significantly reduced the risk of infectious complications (RR: 0.51; 95% CI: 0.27 to 0.98, p=0.04) and shortened the postoperative hospital stay [weighted mean difference (WMD): -3.89; 95% CI: -7.42 to -0.36; p=0.03]. Furthermore, perioperative immunonutrition improved liver function by decreasing the levels of aspartate aminotransferase (AST) in the blood (WMD: -25.4; 95% CI: -39.9 to -10.9, p=0.0006). However, we did not find statistically significant differences in serum alanine aminotransferase (ALT), total bilirubin (TB) and direct bilirubin (DB) levels. There were no statistically significant differences in mortality and rejection reaction.Peri-operative nutrition support adding immunonutrients like glutamine, ω-3 polyunsaturated fatty acids, arginine and ribonucleic acids may improve outcomes in patients undergoing liver transplantation. Due to the limited sample size of the included trials, further large-scale and rigorously designed RCTs are needed.背景与目的：关于肝移植患者围手术期免疫营养支持的疗效还没有达到共识。 我们进行一项meta 分析来评价围手术期应用免疫营养支持对肝移植患者临床 结局和肝功能的影响。方法与研究设计：我们通过Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science 和google scholar 数据库来检索所 有有关肝移植患者围手期免疫营养支持（谷胺酰氨、ω-3 多不饱和脂肪酸、精 氨酸与核糖核酸）与标准营养支持比较的随机对照试验。数据分析采用 Revman 5.2 软件。结果：总共有7 项随机对照试验包括501 例患者纳入研 究。围手术期免疫营养支持可明显降低感染并发症风险（RR 0.51；95% CI 0.27 to 0.98，p=0.04）与缩短术后住院时间（WMD -3.89；95% CI -7.42 to - 0.36，p=0.03）。此外，围手术期免疫营养支持可以通过减少血中天冬氨酸转 氨酶水平（AST）来改善患者肝功能（WMD -25.4；95% CI -39.9 to -10.9， p=0.0006）。同时，我们没有发现两组患者的血清丙氨酸转氨酶、总胆红素及 直接胆红素水平有统计学差异。两组患者的死亡率和排斥反应发生率也没有 统计学差异。结论：围手术期营养支持添加免疫营养素，如谷胺酰氨、ω-3 多 不饱和脂肪酸、精氨酸和核糖核酸可能会改善肝移植患者的临床结局。由于 纳入研究的样本量小，这个结论需要大规模的、设计严谨的随机对照试验来 进一步证实。.