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P078 IMPACT OF ORAL BRANCHED-CHAIN AMINO ACIDS IN PATIENTS WITH CIRRHOTIC LIVER UNDERGOING HEPATIC RESECTION FOR HEPATOCELLULAR CARCINOMA
58 with a specific iron or vitamin D supplementation in case of deficiency, was prescribed to all patients for 3 months. Results: At 3 month, mean (±SD) excess weight loss and BMI were 32±11% and 38.9±6.3, respectively. Before RYGB, all patients had a vitamin D deficiency, and none have corrected it after RYGB. Before RYGB, low ferritin, low iron and mild anemia were found in 1 (5%), 5 (25%) and 2 (10%) patients, respectively. Prevalence of postoperative sideropenia is 35%. Plasma iron was reduced after RYGB (13.3±5.5 vs. 18.4±6.4 microol.L-1, P = 0.02), without any change in ferritin. Hypoalbuminemia was observed in 8 patients (27%) before RYGB. RYGB was associated with an increase of serum albumin (42.0±3.4 vs. 37.3±2.8 g.L-1, P = 0.007). Plasma citrulline was non significantly reduced 3 months after RYGB as compared with baseline (23.8±9.3 vs. 28.2±4.7 micromol.L-1, P = 0.07), while plasma creatinine did not vary (62.4±11.6 vs. 62.8±9.8 micromol.L-1, NS). Conclusion: Although nutritional status seems to improve 3 months after RYGB, the prevalence of sideropenia and vitamin D deficiency is high. Plasma citrulline decreased, but remains in normal ranges, suggesting that the alteration of intestinal absorptive function is not the main factor leading to weight loss after RYGB. Disclosure of Interest: None
P078 IMPACT OF ORAL BRANCHED-CHAIN AMINO ACIDS IN PATIENTS WITH CIRRHOTIC LIVER UNDERGOING HEPATIC RESECTION FOR HEPATOCELLULAR CARCINOMA S. Haji1 , H.H.O. Ohyanagi2 . 1 Surgery, 2 Surgery, Kinki university school, Osakasayamashi, Japan Rationale: Patients with hepatocellular carcinoma (HCC) are at risk of protein-malnutrition or liver failure when undergoing hepatic resection because the majority of these patients suffer from cirrhosis. Branched-chain amino acids (BCAA) have been shown to have beneficial effects on patients with cirrhosis. Methods: We listed 130 patients with histologically fibrotic or cirrhotic liver among all patients with HCC undergoing hepatic resection since November 2000. Eligible patients were divided into study group (n = 37) and control group (n = 93), background, perioperative protein metabolism and clinical outcome of patients were investigated. Patients in study group were given a package of BCAA enriched formula two or three times daily from start at next evening of the operative day to 30th postoperative day (POD). In control group, patients had no nutritional support perioperatively. A total of 50 g/package of Study formula consists of 5.5 g BCAA with other amino acids, various minerals and vitamin. Results: Mean age, hepatic preserve function, blood loss and operation time were similar in both group. Liver fibrosis and cirrhosis were 31 patients and 6 in study group, and 64 and 29 in control group, respectively. Resected liver volume of subsegment, 1 segment and 2 segment were seen 28 patients, 7, and 2 in study group, and 59, 22 and 12 in control group, respectively. Total serum bilirubin and C-reactive protein levels on 5th and 7th POD were significantly lower in patients of study group than those of control. Although perioperative
Poster presentations change of serum albumin level was similar in both groups, BTR (BCAA/tyrosin ratio) of study group was recovered to preoperative value on 30th POD. Looking at clinical outcome, Occurrence of infectious complication was significantly reduced in study group (4/37) compared with control (28/93). Conclusion: Oral administration of BCAAs enriched formula from early period after operation had beneficial effects for cirrhotic patients undergoing hepatic resection for HCC due to the reduction of postoperative liver damage and the elevation of BTR. Disclosure of Interest: None declared.
P079 CHANGES IN PLASMA AMINO ACID LEVELS: A MINIMALLY INVASIVE INNOVATIVE WAY TO DIAGNOSE INTESTINAL REJECTION IN PIGS T. Yandza1 , N. Neveux2 , M. Saint-Paul3 , F. Berthier4 , J. Gugenheim1 , L. Cynober2 , X. Hebuterne5 . 1 Surgery, CHU of Nice, Nice; 2 Biochemistry, Hotel Dieu, Paris; 3 Pathology, 4 Biostatistics, 5 Gastroenterology and Clinical Nutrition, CHU of Nice, Nice, France Rationale: To date, there is no noninvasive or relatively non invasive biomarker for the diagnosis of acute cellular rejection (ACR) which remains a major barrier to improving the clinical results of small bowel transplantation (SBT). As the small intestine is one of the main organ involved in metabolism of amino acids, our working hypothesis was that ACR could be associated with significant changes of plasma amino acids levels.The aim of our study was to determine whether plasma amino acids may be used as markers of ACR in a model of SBT in pigs. Methods: Sixteen female pigs were divided into 2 groups: group 1 (n = 8), controls, segmental autotransplantation; group 2 (n = 8), allotransplantation, nonimmunosuppressed recipients. Intestinal specimens for histological studies were obtained at the end of cold flushing (T0), and on postoperative day 8 (T1). Plasma amino acids levels were measured on samples harvested at T0 and T1. Results: In group 1, intestinal histology revealed no significant changes between T0 and T1 specimens. In contrast, in group 2, graft histology revealed moderate to severe rejection on T1 specimens in all cases. Four plasma amino acids were significantly correlated with the occurrence of acute intestinal rejection: phenylalanine, aspartate, citrulline, and taurine. The threshold of each plasma amino acid variation that best discriminated absence from presence of acute intestinal rejection was determined for each marker with its sensitivity and specificity. A score was determined. An ACR was found in 100% of cases when this score was equal or over 2. Conclusion: Our study suggests for the first time that four plasma amino acid levels may be used in combination as markers of intestinal rejection Disclosure of Interest: No conflict of interest
P078 IMPACT OF ORAL BRANCHED-CHAIN AMINO ACIDS IN PATIENTS WITH CIRRHOTIC LIVER UNDERGOING HEPATIC RESECTION FOR HEPATOCELLULAR CARCINOMA S. Haji1 , H.H.O. Ohyanagi2 . 1 Surgery, 2 Surgery, Kinki university school, Osakasayamashi, Japan Rationale: Patients with hepatocellular carcinoma (HCC) are at risk of protein-malnutrition or liver failure when undergoing hepatic resection because the majority of these patients suffer from cirrhosis. Branched-chain amino acids (BCAA) have been shown to have beneficial effects on patients with cirrhosis. Methods: We listed 130 patients with histologically fibrotic or cirrhotic liver among all patients with HCC undergoing hepatic resection since November 2000. Eligible patients were divided into study group (n = 37) and control group (n = 93), background, perioperative protein metabolism and clinical outcome of patients were investigated. Patients in study group were given a package of BCAA enriched formula two or three times daily from start at next evening of the operative day to 30th postoperative day (POD). In control group, patients had no nutritional support perioperatively. A total of 50 g/package of Study formula consists of 5.5 g BCAA with other amino acids, various minerals and vitamin. Results: Mean age, hepatic preserve function, blood loss and operation time were similar in both group. Liver fibrosis and cirrhosis were 31 patients and 6 in study group, and 64 and 29 in control group, respectively. Resected liver volume of subsegment, 1 segment and 2 segment were seen 28 patients, 7, and 2 in study group, and 59, 22 and 12 in control group, respectively. Total serum bilirubin and C-reactive protein levels on 5th and 7th POD were significantly lower in patients of study group than those of control. Although perioperative
Poster presentations change of serum albumin level was similar in both groups, BTR (BCAA/tyrosin ratio) of study group was recovered to preoperative value on 30th POD. Looking at clinical outcome, Occurrence of infectious complication was significantly reduced in study group (4/37) compared with control (28/93). Conclusion: Oral administration of BCAAs enriched formula from early period after operation had beneficial effects for cirrhotic patients undergoing hepatic resection for HCC due to the reduction of postoperative liver damage and the elevation of BTR. Disclosure of Interest: None declared.
P079 CHANGES IN PLASMA AMINO ACID LEVELS: A MINIMALLY INVASIVE INNOVATIVE WAY TO DIAGNOSE INTESTINAL REJECTION IN PIGS T. Yandza1 , N. Neveux2 , M. Saint-Paul3 , F. Berthier4 , J. Gugenheim1 , L. Cynober2 , X. Hebuterne5 . 1 Surgery, CHU of Nice, Nice; 2 Biochemistry, Hotel Dieu, Paris; 3 Pathology, 4 Biostatistics, 5 Gastroenterology and Clinical Nutrition, CHU of Nice, Nice, France Rationale: To date, there is no noninvasive or relatively non invasive biomarker for the diagnosis of acute cellular rejection (ACR) which remains a major barrier to improving the clinical results of small bowel transplantation (SBT). As the small intestine is one of the main organ involved in metabolism of amino acids, our working hypothesis was that ACR could be associated with significant changes of plasma amino acids levels.The aim of our study was to determine whether plasma amino acids may be used as markers of ACR in a model of SBT in pigs. Methods: Sixteen female pigs were divided into 2 groups: group 1 (n = 8), controls, segmental autotransplantation; group 2 (n = 8), allotransplantation, nonimmunosuppressed recipients. Intestinal specimens for histological studies were obtained at the end of cold flushing (T0), and on postoperative day 8 (T1). Plasma amino acids levels were measured on samples harvested at T0 and T1. Results: In group 1, intestinal histology revealed no significant changes between T0 and T1 specimens. In contrast, in group 2, graft histology revealed moderate to severe rejection on T1 specimens in all cases. Four plasma amino acids were significantly correlated with the occurrence of acute intestinal rejection: phenylalanine, aspartate, citrulline, and taurine. The threshold of each plasma amino acid variation that best discriminated absence from presence of acute intestinal rejection was determined for each marker with its sensitivity and specificity. A score was determined. An ACR was found in 100% of cases when this score was equal or over 2. Conclusion: Our study suggests for the first time that four plasma amino acid levels may be used in combination as markers of intestinal rejection Disclosure of Interest: No conflict of interest