Perioperative nutrition support therapy for combined 'en bloc' liver/pancreas transplantation

Objective: To investigate a reasonable perioperative nutrition support therapy for combined 'en bloc' liver/pancreas transplants (CLPT). Method: The clinical data of 10 patients, 5 with gastrointestinal malignancy and liver metastasis and the other 5 with end-stage liver cirrhosis complicated with insulin-dependent type 2 diabetes mellitus (T2DM) , who had undergone CLPT in our center from May 2004 to September 2010 were retrospectively analyzed. All these patients received preioperative nutrition support, including normal food combined with nutrient solution before surgery, and total parenteral nutrition (TPN) to parenteral nutrition (PN) + enteral nutrition (EN) and to EN after surgery. The intestinal absorption, nutritional status, laboratory test results, and complications were recorded. Results: All recipients experienced a smooth recovery from the procedure, with normal or almost normal liver, pancreas, and duodenum graft functions. Three patients suffered from intestinal fistula, and all of them received TPN therapy; two patients died of multiple organ failure and one recovered from the complication. The remaining seven patients had smooth transition from TPN to EN. Of the 5 patients with malignancies, three died of multiple organ failure and 2 died of cancer recurrence. Of the 5 patients with liver cirrhosis and T2DM, four patients survived and 1 patient died of graft-verse-host disease. Conclusion: Rational perioperative nutrition support is important for the successful recovery after CLPT.