Preoperative carbohydrate loading reduces perioperative insulin resistance and hastens functional recovery of remnant liver after living donor hepatectomy: An open-label randomized controlled trial.
Kumar, M., et al.Hepatology International 2025 [record in progress].
Aims
The aim of this study was to investigate the role of preoperative carbohydrate (CHO) loading on reducing perioperative insulin resistance (PIR) and live donor hepatectomy outcomes.
Interventions
Participants were randomised to either the CHO group or the fasting group.
Participants
70 patients that underwent donor hepatectomy for elective live donor liver transplantation.
Outcomes
The primary outcomes were PIR. The secondary outcomes were time taken for normalisation of serum total bilirubin level and international normalized ratio (INR), infammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) levels, incidence of postoperative nausea and vomiting (PONV) in the early postoperative period, length of hospital stay (LOS), and postoperative complications.
Follow-up
72 hours post-surgery
CET Conclusions
This is an interesting report of a well-conducted study in living liver donation. The authors investigated whether or not pre-operative carbohydrate loading could reduce post-operative insulin resistance and multiple other outcomes and potential downstream effects. The study builds on the experience of enhanced recovery programmes in other surgical specialties and operations. The study was conducted in a single-centre, and was not blinded (which would have been possible) however the results are mostly objective and this supports the conclusions. The study was powered for its primary outcome, that of insulin resistance, and therefore may be underpowered for some of the downstream potential outcomes. The pre-operative carbohydrate intake made a significant improvement in post-operative glucose control, post-operative nausea and time to soft diet intake. There was also an earlier normalisation of serum bilirubin. The study was likely too small to be powered for other outcomes. It is also a shame that no patient-recorded outcomes were recorded and that the opportunity to blind the study was not taken. However, this study clearly supports the use of pre-operative carbohydrate loading in this patient group.
Data analysis
Strict intention-to-treat analysis
Trial registration
ClinicalTrials.gov - NCT05293444