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Preoperative metabolic status is associated with different evolution of resting energy expenditure after liver transplant in adults

Ana Brito-costa, Luís Pereira-da-silva, Ana Luisa Papoila, Marta Alves, Élia Mateus, Fernando Nolasco, Eduardo Barroso

Introduction: The resting energy expenditure (REE) evolution after liver transplantation is not fully understood.Objective: To assess longitudinally the REE evolution in adults undergoing liver transplantation, in association with other nutritional measurements that characterize the metabolic profile.Methods: A single-center cohort of consecutive end-stage liver disease patients with indication for liver transplantation was recruited. REE, subjective global assessment (SGA), handgrip strength and body composition measurements were assessed before transplantation (T0) and at median nine (T1) and 36 (T2) days after transplantation. Mixed effects regression models were used for analysis.Results: Fifty-six patients with a mean age of 53.7 (8.5) years were included; 87.5% were males. In T0, 41% of patients were normometabolic, 37.5% were hypometabolic and 21.4% were hypermetabolic. After transplantation, the mean REE decreased progressively in patients initially hypermetabolic and the opposite occurred in those initially hypometabolic. The REE evolution was positively associated with body weight (β= 9.6, p < 0.001) and energy intake (β= 13.6, p = 0.005) in the whole sample; it was positively associated with body weight (β= 7.1, p = 0.018) and percentage of energy intake from lipids (β= 18.9, p = 0.003) in initially hypometabolic patients, and positively associated with body weight (β= 14.1, p < 0.001) and negatively associated with SGA-undernourishment (β= -171, p = 0.007) in initially normometabolic patients.Conclusion: Different REE evolutions after liver transplantation are associated with the preoperative metabolic status. In patients initially hypometabolic, the REE evolution is positively associated with body weight and percentage of energy intake from lipids, and in those initially normometabolic, it is positively associated with body weight and negatively associated with SGA-undernourishment. 

Palabras Clave: body composition; liver transplantation; metabolic status; nutritional assessment; resting energy expenditure

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