A low pretransplant peripheral blood mononuclear cell complex I activity predicts metabolic disturbances and inability to regain fat free mass in cirrhotic patients undergoing liver transplantation

Liver cirrhosis is associated with malnutrition and often, after liver transplantation, with the development of obesity and the inability to gain lean body mass. We have previously shown that peripheral blood mononuclear cell (PBMNC) complex I activity could be an appropriate marker for nutritional assessment. In this context, we hypothesized that a low pretransplant PBMNC complex I activity may predict a poor nutritional status in cirrhotic patients undergoing liver transplantation. Fifteen cirrhotic patients (CP) (8 men and 7 women) were recruited and investigated before and 4 months after liver transplantation. Body weight, body composition by DEXA, anthropometric measures (triceps skinfold thickness and midarm muscle circumference), resting energy expenditure, respiratory quotient and PBMNC complex I activity were measured on both time points. Patients were divided into 2 groups depending on their pretransplant PBMNC complex I activity (low vs high complex I activity [CP_{low CI} vs CP_{high CI}]), using as an arbitrary cutoff value-the mean complex I activity observed in age-matched healthy controls. Before transplantation, the CP_{low CI} group who showed a lower complex I activity (2.11 ± 0.53 vs 4.54 ± 0.98 nmol/min per milligram of protein, P < .01) was significantly younger (44 ± 9 vs 62 ± 8 years old, P < .01); no differences were observed for any other nutritional parameters when compared to the CP_{high CI} group. After transplantation, only the CP_{low CI} group demonstrated a significant increase of complex I activity (+77%, P < .01), respiratory quotient (+10.5%, P < .02), triceps skinfold thickness (+126%, P < .005), and a significant decrease of fat-free mass (-8%, P < .01). In summary, our findings indicate that a low pretransplant PBMNC complex I activity in cirrhotic patients could be a useful marker of poor nutritional status despite the lack of traditional indicators of malnutrition by predicting metabolic disturbances and an inability to regain fat-free mass after liver transplantation.