Effects of glutamine-enriched early enteral nutrition on intestinal mucosal barrier injury after liver transplantation in rats

Objective To observe the effect of glutamine-enriched early enteral nutrition on intestinal mucosal barrier injury after orthotopic liver transplantation in rats.Method Male Wistar rats,the recipients were randomly divided into three groups:control group (control group,n =10),orthotopic liver transplantation group (OLT group,n =30) and glutamine-enriched early enteral nutrition group (EEN group,n =30).Only dissecting hepatoduodenal ligament was performed in control group,and OLT was performed from Wistar to Wistar rats by modified two-cuff method in OLT group and EEN group.For EEN group,recipients were supplied with Nutrison Fiber (125 ml/kg every day) plus Gln (0.3 g/kg every day) for 3 days before and 3 h after surgery by gastric perfusion.For OLT group,the same volume of normal saline was administered instead of the Nutrison in the same time.No special treatment was given in control group.The levels of plasma endotoxin,D-lactic acid,and TNF-α were determined at different time points in the three groups.The ultrastructural changes of ileal mucosa were observed under the transmission electron microscopy.At the same time,the remaining 5 rats per group were used for observing the lifetime.Result As compared with control group at 12,24 and 72 h,the levels of plasma endotoxin,D-lactic acid,and TNF-α were significantly increased in OLT group and EEN group (P＜0.01),and as compared with OLT group,the above-mentioned indexes were obviously decreased in EEN group at 24 and 72 h (P＜ 0.01).The ileal mucosal epithelial clearance in control was normal,and microvilli arranged neatly under the electron microscope.the ultrastructure damage in OLT group was more serious than in EEN group at 12,24,and 72 h.As compared with control group at 12,24,and 72 h,the expression levels of TNF-α mRNA were significantly increased in OLT group and EEN group (P＜0.01),and as compared with OLT group,the expression levels of TNF-α mRNA were obviously decreased in EEN group (P＜0.01).The survival time in cntrol group was significantly longer than in OLT group and EEN group (P＜0.05),and as compared with OLT group,the survival time in EEN group was obviously extended (P＜0.05).Conclusion OLT can lead to the damage of intestinal mucosal barrier,and glutamine-enriched early enteral nutrition is a potent protection against intestinal mucosal barrier injury and prolongs the survival time of rats after OLT. Key words: Rats;  Liver transplantation;  Enteral nutrition;  Glutamine;  Intestinal mucosal barrier