Effects of Preoperative Long-Term Immunonutrition in Patients Listed for Liver Transplantation

NCT ID: NCT00495859

Last Updated: 2008-04-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

156 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-04-30

Study Completion Date

2011-04-30

Brief Summary

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Patients with endstage liver disease characteristically are malnourished which is associated with poor outcome. Formulas enriched with arginine,ω3 fatty acids, and nucleotides potentially improve their nutritional status. This randomized placebo-controlled double blind multicenter clinical trial with longterm preoperative supplementation with such an enriched formula will evaluate evaluate effects of such formulas on patients' quality of life, survival, and posttransplant morbidities.

Detailed Description

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Background. Patients with end stage liver disease characteristically are malnourished which is associated with poor outcome. Formulas enriched with arginine, ω-3 fatty acids, and nucleotides, "immunonutrients", potentially improve their nutritional status. This study is designed to evaluate the clinical outcome of long-term "immunonutrition" of patients with end-stage liver disease while on the waiting list for liver transplantation.

Methods / design. A randomized controlled double blind multi-center clinical trial with two parallel groups comprising a total of 142 newly registered patients for primary liver transplantation has been designed to assess the safety and efficacy of the long-term administration of ORAL IMPACT®, an "immunonutrient" formula, while waiting for a graft. Patients will be enrolled the day of registration on the waiting list for liver transplantation. Study ends on the day of transplantation. Primary endpoints include patients' nutritional and physiological status, as measured by mid-arm muscle area, triceps skin fold thickness, grip strength, and fatigue score, as well as patients' health related quality of life. Furthermore, patients will be followed for 12 postoperative weeks to evaluate anabolic recovery after transplantation as shown by reduced post-transplant mechanical ventilation, hospital stay, wound healing, infectious morbidities (pneumonia, intra-abdominal abscess, sepsis, line sepsis, wound infection, and urinary tract infection), acute and chronic rejection, and mortality.

Discussion. Formulas enriched with arginine, ω-3 fatty acids, and nucleotides have been proven to be beneficial in reducing postoperative infectious complications and length of hospital stay among the patients undergoing elective gastrointestinal surgery. Possible mechanisms include downregulation of the inflammatory responses to surgery and immune modulation rather than a sole nutritional effect.

Conditions

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Newly Registered Patients for Primary Liver Transplantation

Keywords

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Immunonutrition immune enhancing diets arginine ω-3 fatty acids nucleotides liver transplantation clinical trial

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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1

Study group will receive formula enriched with arginine, ω-3 fatty acids, and nucleotides once daily

Group Type ACTIVE_COMPARATOR

Immunonutrition

Intervention Type DIETARY_SUPPLEMENT

food for special medical purpose (FSMP)

2

controls receive an isocaloric isonitrogenous non-specific nutritional support

Group Type ACTIVE_COMPARATOR

food for special medical purposes (FSMP)

Intervention Type DIETARY_SUPPLEMENT

an isocaloric isonitrogenous non-specific nutritional support

Interventions

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Immunonutrition

food for special medical purpose (FSMP)

Intervention Type DIETARY_SUPPLEMENT

food for special medical purposes (FSMP)

an isocaloric isonitrogenous non-specific nutritional support

Intervention Type DIETARY_SUPPLEMENT

Other Intervention Names

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ORAL IMPACT® IMPACT-Control Supplement

Eligibility Criteria

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Inclusion Criteria

* Men and women between 18 and 68 years of age
* Scheduled for first liver transplantation
* Written informed consent
* Protein-calorie malnutrition: Mid-arm muscle area (MAMA) \<85% standard

Exclusion Criteria

* Patients \< 18 and \> 68 years
* Pregnant or nursing women
* History of hypersensitivity to arginine, ω-3 fatty acids, or nucleotides
* Inability to take oral nutrition
* Patients with fulminant or subacute hepatic failure requiring urgent transplantation
* Mental condition rendering the subject incapable to understand the nature, scope, and consequences of the trial
* Simultaneous participation in another clinical trial
Minimum Eligible Age

18 Years

Maximum Eligible Age

68 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Novartis

INDUSTRY

Sponsor Role collaborator

Heidelberg University

OTHER

Sponsor Role lead

Responsible Party

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Dept. of surgery, University of Heidelberg

Principal Investigators

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Peter Schemmer, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Surgery, Ruprecht-Karls University of Heidelberg, Germany

Locations

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Department of Surgery, Ruprecht-Karls University

Heidelberg, Baden-Wurttemberg, Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Peter Schemmer, MD

Role: CONTACT

Phone: 004962215636500

Email: [email protected]

Arash Nickkholgh, MD

Role: CONTACT

Phone: 004962215638584

Email: [email protected]

Facility Contacts

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Peter Schemmer, MD

Role: primary

Arash Nickkholgh, MD

Role: backup

References

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Nickkholgh A, Schneider H, Encke J, Buchler MW, Schmidt J, Schemmer P. PROUD: effects of preoperative long-term immunonutrition in patients listed for liver transplantation. Trials. 2007 Aug 27;8:20. doi: 10.1186/1745-6215-8-20.

Reference Type DERIVED
PMID: 17723147 (View on PubMed)

Related Links

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http://www.klinikum.uni-heidelberg.de/

Heidelberg University Hospital

http://www.chirurgieinfo.com

Learn more about the Department of Surgery at Ruprecht-Karls University of Heidelberg

Other Identifiers

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PROUD

Identifier Type: -

Identifier Source: org_study_id