The effect of nutritional and hormonal supplementation on protein synthesis immediately after liver transplantation.

We have previously shown that immediately after liver transplantation (LT) the porcine recipient exhibits elevated plasma glucagon, increased fractional synthetic rate (FSR) of fibrinogen, and decreased FSR of fixed or structural liver proteins. The purpose of this study was to evaluate the effect of nutritional and hormonal supplementation on these observations 24 h after LT. Two groups of nine pigs were studied 1 day after LT using radioisotopic and arteriovenous difference techniques. A control group underwent LT with saline infusion and a supplemented group underwent LT with infusion of glucose, amino acids (6 and 1.06 mg/kg · min, respectively), and intraportal insulin (0.6 mU/kg · min) and glucagon (1.3 ng/kg · min). Primed constant infusions of [3H]leucine were used to determine leucine flux, an estimate of whole body protein breakdown, and fractional synthetic rates (FSR). The following changes were noted with supplementation: elevated plasma insulin (6 ± 1 versus 29 ± 4 μU/ml, control versus supplemented, respectively,P< 0.05), decreased glucagon to normal levels (323 ± 65 versus 102 ± 12 pg/ml,P< 0.05), decreased fibrinogen FSR (108 ± 15 versus 70 ± 6%/day,P< 0.025), and increased fixed liver protein FSR (8 ± 1 versus 13 ± 2%/day,P< 0.05, respectively). Albumin FSR was unaltered by supplementation (8 ± 2 versus 6 ± 1%/day, respectively). Nutritional and hormonal supplementation immediately after LT restored the measured protein synthesis in the allograft to near normal levels 1 day after transplantation.