Bacterial sepsis and perioperative nutritional support therapy in living donor liver transplantation

Bacterial sepsis is a frequent occurrence during the first 1-2 months after liver transplantation under immunosuppressive therapy. Despite recent advances in perioperative management and surgical techniques, postoperative mortality and morbidity rates are still associated with infectious complications, such as bacterial sepsis, after liver transplantation. Furthermore, bacterial sepsis is the most frequent cause of in-hospital death after living donor liver transplantation (LDLT). In this chapter, the etiology, outcomes, and risk factors of bacterial sepsis after LDLT are discussed. In addition, we focus on the effect of perioperative nutritional support in LDLT for preventing bacterial sepsis after LDLT. LDLT involves a smaller graft size and scheduled nonemergent surgery compared with deceased donor liver transplantation. A smaller graft size is the main disadvantage of adult-to-adult LDLT because it results in increased portal venous pressure, impaired bowel motility, bacterial translocation, ascites production, and hyperbilirubinemia. In the last 2 decades, nutritional support has been recognized as a vital component for the management of critically ill patients, by delivering preoperative essential substrates and nutrition using enteral feeding, to aid patient recovery. In particular, preoperative branchedchain amino acid supplementation might reduce the incidence of postoperative bacterial sepsis after LDLT. Additionally, early enteral nutrition is associated with a significantly reduced risk of developing bacterial sepsis after LDLT. Therefore, poor nutritional status of pre-transplants can be improved by using nutritional support, and the high infectious status of posttransplants under immunosuppressive therapy can be improved with initiation of early postoperative enteral nutrition. Improved nutrition supports a functional immune system, and reduces septic morbidity and mortality in patients with liver transplantation.