| Objectives We investigated the effect of an intravenous glutamine-dipeptide enriched enteral nutrition on insulin resistance and clinical outcome in patients after liver transplantation.Methods A prospective, randomized and controlled study. Thirty patients from a single liver transplantation centre were randomly allocated to receive an intravenous glutamine-dipeptide enriched enteral nutrition or a control isocaloric, isonitrogenic parenteral nutrition. Informed consent was obtained from all patients or their relatives according to Chinese laws. The study protocol was approved by the division of scientific studies management. The study conducted under glucose clamping by a continuous infusion of insulin, with the use of a pump. Insulin infusion was started if the blood glucose level exceeded 6.1 mmol/L, and the infusion was adjusted to maintain the normoglycaemia (4.4-6.1 mmol/L). The glucose level, insulin consumption, death occurrence, infectious complication, acute rejection, length of hospital stay(LOS), and cost of hospitalization were recorded. SPSS 11.5 was used for statistical analysis. Continuous data was analyzed byANNOVA or Mann-Whitney-test according the distribution status. The x2 test was chosen for the analysis of the categorical data.Results Twenty-six patients successfully completed nutrition therapy. Glucose control and insulin consumption: In two groups, the mean glucose of patients were controlled on expected level, there was no significance difference between groups. Gln-dipeptide group consumed less insulin than control group (69.8±30.3 vs. 95.9±27.6)IU, mean difference (-26.1±11.4) IU, P=0.031. The mortality was higher in control group than gln-dipeptide enriched enteral nutrition group (4/13 vs. 0/13), there was no statistical significance but a decreasing trend favor to glutamine group (.P=0.096). The number of infected patients was smaller in the gln-dipeptide enriched enteral nutrition group (6/13 vs. 10/13), a reduction trend favor to glutamine group was showed (P=0.097). The length of hospital stay in the glutamine group was (41.5±16.3) days, which was (21.6±8.8) days less than control group (P=0.018). The cost of ICU in study group was less than control group, mean difference (-87774±38649) RMB, P=0.032.The cost of hospitalization, study group significant less than control group, mean difference was(-89603±40130)RMB, i>=0.035.Conclusion Glutamine-dipeptide enriched enteral nutrition attenuated the insulin resistance in liver transplantation patients, and may decreasing length of hospitalization and cost. For the small sample of this trial, well-designed and larger prospective randomized controlled studies are necessary. |
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