Perioperative immunonutrition in patients undergoing liver transplantation: A randomized double‐blind trial

Randomized, double-blind trial in adults with end-stage liver disease who were wait-listed for orthotopic liver transplantation at Auckland City Hospital, New Zealand. Patients with acute liver failure or on retransplant lists were excluded. In the immunonutrition arm, 52 participants received the active supplement; 49 participants were in the control arm.

Perioperative immunonutrition was given as Oral Impact powder, 2 sachets per day (74 g each) orally before transplant; when reconstituted, this provided 600 mL/day at 1 kcal/mL containing 7.5 g arginine, 2 g n-3 fatty acids, and 0.8 g ribonucleic acid. After surgery, enteral nutrition was started within about 12 hours via nasojejunal tube and the Oral Impact or control product was continued at 600 mL/day until at least postoperative day 5.

Perioperative immunonutrition did not improve preoperative nutritional status or postoperative outcomes after liver transplantation. Total body protein changed by 0.06 6 0.15 kg in the immunonutrition group versus 0.12 6 0.10 kg in control, with no significant between-group difference (P = 0.74). Total body fat, grip strength, respiratory muscle strength, and fatigue also showed no meaningful benefit. Preoperative adverse events were similar, and graft-related outcomes were comparable, with rejection in 19 versus 21 and steroid-resistant rejection in 1 versus 1.

The active-arm sample was modest, and supplementation exposure varied widely, with days on supplement ranging from 0 to 480 in the immunonutrition group. The transplant population was clinically heterogeneous, with differences in liver disease etiology and baseline nutritional status across groups. Several outcomes were reported with limited detail, which constrains interpretation of smaller or secondary effects.