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Wang M, Shui AM, Ruck J, Huang CY, Verna EC, King EA, Ladner DP, Ganger D, Kappus M, Rahimi R, Tevar AD, Duarte-Rojo A, Lai JC. Clinically relevant cut-points for changes in the Liver Frailty Index are associated with waitlist mortality in patients with cirrhosis. Liver Transpl 2024:01445473-990000000-00406. [PMID: 38900010 DOI: 10.1097/lvt.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/25/2024] [Indexed: 06/21/2024]
Abstract
Physical frailty is a critical determinant of mortality in patients with cirrhosis and can be objectively measured using the Liver Frailty Index (LFI), which is potentially modifiable. We aimed to identify LFI cut-points associated with waitlist mortality. Ambulatory adults with cirrhosis without HCC awaiting liver transplantation from 9 centers from 2012 to 2021 for ≥3 months with ≥2 pre-liver transplantation LFI assessments were included. The primary explanatory variable was the change in LFI from first to second assessments per 3 months (∆LFI); we evaluated clinically relevant ∆LFI cut-points at 0.1, 0.2, 0.3, and 0.5. The primary outcome was waitlist mortality (death or delisting for being too sick), with transplant considered as a competing event. Among 1029 patients, the median (IQR) age was 58 (51-63) years; 42% were female; and the median lab Model for End-Stage Liver Disease-Sodium at first assessment was 18 (15-22). For each 0.1 improvement in ∆LFI, the risk of overall mortality decreased by 6% (cause-specific hazard ratio: 0.94, 95% CI: 0.92-0.97, p < 0.001). ∆LFI was associated with waitlist mortality at cut-points as low as 0.1 (cause-specific hazard ratio: 0.63, 95% CI: 0.46-0.87) and 0.2 (HR: 0.61, 95% CI: 0.42-0.87). An improvement in LFI per 3 months as small as 0.1 in the pre-liver transplantation period is associated with a clinically meaningful reduction in waitlist mortality. These data provide estimates of the reduction in mortality risk associated with improvements in LFI that can be used to assess the effectiveness of interventions targeting physical frailty in patients with cirrhosis.
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Affiliation(s)
- Melinda Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Amy M Shui
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jessica Ruck
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - Elizabeth A King
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniela P Ladner
- Northwestern University Transplant Outcomes Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Daniel Ganger
- Northwestern University Transplant Outcomes Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Matthew Kappus
- Division of Gastroenterology and Hepatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert Rahimi
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas, USA
| | - Amit D Tevar
- Department of Surgery and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andres Duarte-Rojo
- Northwestern University Transplant Outcomes Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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2
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Hahn M, Wood A, Hasse JM. Nutrition support management of organ transplant recipients in the acute posttransplant phase. Nutr Clin Pract 2024; 39:45-58. [PMID: 38081296 DOI: 10.1002/ncp.11104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 01/13/2024] Open
Abstract
Patients who undergo solid organ transplant can have an extensive and challenging postoperative course. The chronicity of the disease state prior to transplant in combination with transplant-specific complications and immunosuppressant medications can lead to distinct challenges that are not observed in other critically ill patients. Although the manifestation of posttransplant complications may be specific to the organ being transplanted, there are common transplant challenges that affect nutrition therapy in these patients. Effects of malnutrition, metabolic aberrations, and posttransplant organ dysfunction should be considered when developing a nutrition care plan for patients in the immediate posttransplant phase. This article addresses the various complications that can arise in the immediate posttransplant phase among patients undergoing solid organ transplant and the appropriate nutrition interventions or considerations for this specialized patient population.
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Affiliation(s)
- Michaelann Hahn
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Abby Wood
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Jeanette M Hasse
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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3
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Dowhan L, Moccia L, Fujiki M. Nutrition care for the adult post-intestinal transplant patient. Nutr Clin Pract 2024; 39:60-74. [PMID: 38069605 DOI: 10.1002/ncp.11100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 01/13/2024] Open
Abstract
Intestinal transplantation has emerged as an accepted treatment choice for individuals experiencing irreversible intestinal failure. This treatment is particularly relevant for those who are not candidates or have poor response to autologous gut reconstruction or trophic hormone therapy, and who can no longer be sustained on parenteral nutrition. One of the main goals of transplant is to eliminate the need for parenteral support and its associated complications, while safely restoring complete nutrition autonomy. An intestinal transplant is a complex process that goes beyond merely replacing the intestines to provide nourishment and ceasing parenteral support. It requires an integrated management approach in the pretransplant and posttransplant setting, and high-quality nutrition treatment is one of the cornerstones leading to favorable outcomes and long-term management. Since the outset of intestinal transplant in the early 2000s, there is observed improvement of achieving nutrition autonomy sooner in the initial posttransplant phase; however, the development of nutrition complications in the chronic posttransplant period remains a long-term risk. This review delineates the decision-making process and clinical protocols used to nutritionally manage and monitor pre- and post-intestine transplant patients.
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Affiliation(s)
- Lindsay Dowhan
- Center for Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lisa Moccia
- Center for Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Masato Fujiki
- Center for Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio, USA
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4
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Mascherini G, Corsi M, Falconi E, Cebrián-Ponce Á, Checcucci P, Pinazzi A, Russo D, Gitto S, Sofi F, Stefani L. Unsupervised Exercise Intervention vs. Adherence to a Mediterranean Diet Alone: The Role of Bioelectrical Impedance Vector Analysis and Cardiovascular Performance in Liver-Transplanted Recipients. Nutrients 2024; 16:190. [PMID: 38257083 PMCID: PMC10819110 DOI: 10.3390/nu16020190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Cardiovascular disease is one of the leading causes of mortality after liver transplantation. Body composition and cardiovascular performance assessment represent a potential approach for modulating lifestyle correction and proper follow-up in chronic disease patients. This study aimed to verify the additional role of an unsupervised physical activity program in a sample of male liver transplant recipients who follow the Mediterranean diet. (2) Methods: Thirty-three male liver transplant recipients were enrolled. Sixteen subjects followed a moderate-intensity home exercise program in addition to nutritional support, and seventeen received advice on the Mediterranean diet. After six months, bioelectrical vector impedance analysis (BIVA) and cardiopulmonary exercise testing (CPET) were performed. (3) Results: No differences in CPET (VO2 peak: exercise 21.4 ± 4.1 vs. diet 23.5 ± 6.5 mL/kg/min; p = 0.283) and BIVA (Z/H: exercise 288.3 ± 33.9 vs. diet 310.5 ± 34.2 Ω/m; p = 0.071) were found. Furthermore, the BIVA values of resistance correlate with the submaximal performance of the Ve/VCO2 slope (R = 0.509; p < 0.05) and phase angle with the maximal effort of the VO2 peak (R = 0.557; p < 0.05). (4) Conclusions: Unsupervised physical exercise alone for six months does not substantially modify liver transplant recipients' cardiovascular performance and hydration status, despite their adherence to a Mediterranean diet. The body composition analysis is useful to stratify the risk profile, and it is potentially associated with better outcomes in transplanted subjects.
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Affiliation(s)
- Gabriele Mascherini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.); (M.C.); (E.F.); (P.C.); (A.P.); (D.R.); (S.G.); (F.S.)
| | - Marco Corsi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.); (M.C.); (E.F.); (P.C.); (A.P.); (D.R.); (S.G.); (F.S.)
| | - Edoardo Falconi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.); (M.C.); (E.F.); (P.C.); (A.P.); (D.R.); (S.G.); (F.S.)
| | - Álex Cebrián-Ponce
- Barcelona Sports Sciences Research Group, Institut Nacional d’Educació Física de Catalunya (INEFC), University of Barcelona (UB), 08038 Barcelona, Spain;
| | - Pietro Checcucci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.); (M.C.); (E.F.); (P.C.); (A.P.); (D.R.); (S.G.); (F.S.)
| | - Antonio Pinazzi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.); (M.C.); (E.F.); (P.C.); (A.P.); (D.R.); (S.G.); (F.S.)
| | - Domenico Russo
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.); (M.C.); (E.F.); (P.C.); (A.P.); (D.R.); (S.G.); (F.S.)
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.); (M.C.); (E.F.); (P.C.); (A.P.); (D.R.); (S.G.); (F.S.)
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.); (M.C.); (E.F.); (P.C.); (A.P.); (D.R.); (S.G.); (F.S.)
| | - Laura Stefani
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (G.M.); (M.C.); (E.F.); (P.C.); (A.P.); (D.R.); (S.G.); (F.S.)
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Serper M, Jones LS, Clement T, Reddy RK, Reese PP. A randomized, controlled, prehabilitation intervention to maximize early recovery (PRIMER) in liver transplantation. Liver Transpl 2024; 30:10-19. [PMID: 37379030 PMCID: PMC10755068 DOI: 10.1097/lvt.0000000000000198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
Frailty and impaired functional status are associated with adverse outcomes on the liver transplant (LT) waitlist and after transplantation. Prehabilitation prior to LT has rarely been tested. We conducted a 2-arm patient-randomized pilot trial to evaluate the feasibility and efficacy of a 14-week behavioral intervention to promote physical activity prior to LT. Thirty patients were randomized 2:1 to intervention (n = 20) versus control (n = 10). The intervention arm received financial incentives and text-based reminders linked to wearable fitness trackers. Daily step goals were increased by 15% in 2-week intervals. Weekly check-ins with study staff assessed barriers to physical activity. The primary outcomes were feasibility and acceptability. Secondary outcomes included mean end-of-study step counts, short physical performance battery, grip strength, and body composition by phase angle. We fit regression models for secondary outcomes with the arm as the exposure adjusting for baseline performance. The mean age was 61, 47% were female, and the median Model for End-stage Liver Disease sodium (MELD-Na) was 13. One-third were frail or prefrail by the liver frailty index, 40% had impaired mobility by short physical performance battery, nearly 40% had sarcopenia by bioimpedance phase angle, 23% had prior falls, and 53% had diabetes. Study retention was 27/30 (90%; 2 unenrolled from intervention, 1 lost to follow-up in control arm). Self-reported adherence to exercise during weekly check-ins was about 50%; the most common barriers were fatigue, weather, and liver-related symptoms. End-of-study step counts were nearly 1000 steps higher for intervention versus control: adjusted difference 997, 95% CI, 147-1847; p = 0.02. On average, the intervention group achieved daily step targets 51% of the time. A home-based intervention with financial incentives and text-based nudges was feasible, highly accepted, and increased daily steps in LT candidates with functional impairment and malnutrition.
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Affiliation(s)
- Marina Serper
- Division of Gastroenterology & Hepatology, University
of Pennsylvania Perelman School of Medicine
- Leonard Davis Institute of Health Economics, University of
Pennsylvania
| | - Lauren S Jones
- Philadelphia College of Osteopathic Medicine, Philadelphia,
Pennsylvania, USA
| | - Thomas Clement
- Division of Gastroenterology & Hepatology, University
of Pennsylvania Perelman School of Medicine
| | - Rajender K Reddy
- Division of Gastroenterology & Hepatology, University
of Pennsylvania Perelman School of Medicine
| | - Peter P Reese
- Division of Gastroenterology & Hepatology, University
of Pennsylvania Perelman School of Medicine
- Leonard Davis Institute of Health Economics, University of
Pennsylvania
- Philadelphia College of Osteopathic Medicine, Philadelphia,
Pennsylvania, USA
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6
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Mallick S, Sakowitz S, Bakhtiyar SS, Chervu N, Valenzuela A, Kim S, Benharash P. Administrative coding of frailty: Its association with clinical outcomes and resource use in kidney transplantation. Clin Transplant 2024; 38:e15200. [PMID: 38041448 DOI: 10.1111/ctr.15200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Although not formalized into current risk assessment models, frailty has been associated with negative postoperative outcomes in many specialties. However, national analyses of the association between frailty and post-transplant outcomes following kidney transplantation (KT) are lacking. METHODS This was a retrospective cohort study of adults undergoing KT from 2016 to 2020 in the Nationwide Readmissions Databases. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator. RESULTS Of an estimated 95 765 patients undergoing KT during the study period, 4918 (5.1%) were frail. After risk adjustment, frail patients were associated with significantly higher odds of in-hospital mortality (AOR 2.17, 95% CI: 1.33-3.57) compared to their non-frail counterparts. Our findings indicate that frail patients had an average increase in postoperative hospital stay of 1.44 days, a $2300 increase in hospitalization costs, as well as higher odds of developing a major perioperative complication as compared to their non-frail counterparts. Frailty was also associated with greater adjusted risk of non-home discharge. CONCLUSIONS Frailty, as identified by administrative coding, is independently associated with worse surgical outcomes, including increased mortality and resource use, in adults undergoing KT. Given the already limited donor organ pool, novel efforts are needed to ensure adequate optimization and timely post-transplantation care of the growing frail cohort undergoing KT.
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Affiliation(s)
- Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alberto Valenzuela
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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7
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Xiao L, Dai M, Zhao F, Shen Y, Kwan RYC, Salvador JT, Zhang L, Luo Y, Liu Q, Yang P. Assessing the risk factors associated with sarcopenia in patients with liver cirrhosis: a case-control study. Sci Rep 2023; 13:21845. [PMID: 38071233 PMCID: PMC10710435 DOI: 10.1038/s41598-023-48955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
Sarcopenia is a disease characterized by decreased muscle mass and strength, affecting 20-70% of patients with cirrhosis, and is associated with poor prognosis, complications, and high mortality. At present, the epidemiological investigation of sarcopenia in patients with liver cirrhosis is relatively limited, and because of the differences in population characteristics, regions, diagnostic criteria and diagnostic tools, the prevalence of sarcopenia in various studies varies greatly. The definition of sarcopenia in this study adopted the criteria of the Asian Working Group on Sarcopenia (AWGS 2019), including muscle mass and muscle strength / physical performance. A total of 271 patients with liver cirrhosis were included in this cross-sectional study to explore the influencing factors of sarcopenia in patients with liver cirrhosis. The prevalence of sarcopenia was 27.7%, 27.3% in male and 28.4% in female. The results of binary logistic regression analysis showed that age, physical activity, BMI, mid-upper arm muscle circumference, hepatic encephalopathy, nutritional status, alkaline phosphatase, albumin and total cholesterol were significantly correlated with the occurrence of sarcopenia in patients with liver cirrhosis. After adjusting for the potential influencing factors, it was found that the correlation between age and sarcopenia was weakened (OR = 0.870, 95% CI 0.338-2.239). The current findings show that sarcopenia is common in patients with cirrhosis and is independently associated with age, physical activity, BMI, nutritional status, and albumin, and serum alkaline phosphatase and total cholesterol are associated with the development of sarcopenia. Regular exercise may help maintain the grip strength of patients with cirrhosis and delay the deterioration of liver function.
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Affiliation(s)
- LeYao Xiao
- Deparment of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- School of Nursing, Zunyi Medical University, Zunyi, 563000, China
| | - Mei Dai
- Deparment of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- School of Nursing, Zunyi Medical University, Zunyi, 563000, China
| | - Fei Zhao
- Deparment of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- School of Nursing, Zunyi Medical University, Zunyi, 563000, China
| | - YouShu Shen
- Deparment of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- School of Nursing, Zunyi Medical University, Zunyi, 563000, China
| | | | - Jordan Tovera Salvador
- Philippine Women's University, Manila, Philippines
- Nursing Education Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Li Zhang
- School of Nursing, Zunyi Medical University, Zunyi, 563000, China.
| | - YaWen Luo
- Deparment of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Qian Liu
- Deparment of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- School of Nursing, Zunyi Medical University, Zunyi, 563000, China
- Nursing Department of the Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ping Yang
- Deparment of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.
- School of Nursing, Zunyi Medical University, Zunyi, 563000, China.
- Nursing Department of the Affiliated Hospital of Zunyi Medical University, Zunyi, China.
- Philippine Women's University, Manila, Philippines.
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8
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Saiman Y. The next step in frailty assessment: Biomarker development. Liver Transpl 2023; 29:1023-1024. [PMID: 37204163 DOI: 10.1097/lvt.0000000000000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Yedidya Saiman
- Department of Medicine, Section of Hepatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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9
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De Gasperi A, Petrò L, Cerutti E. Liver Transplantation and the Elderly Candidate: Perioperative Considerations. Anesthesiol Clin 2023; 41:595-611. [PMID: 37516497 DOI: 10.1016/j.anclin.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Pioneered by Thomas Starzl in the early 1970s, liver transplant (LT) is nowadays often considered a final intervention and standard of care to cure many forms of acute and chronic end-stage liver diseases. Started in recipients younger than 60 years old, LT indications are now much broader, and at least, one-fifth of the candidates are older than 65 years. Problems associated with ageing and frailty in LT recipients and their impact on the entire perioperative course are discussed according to a modern anesthesiological perspective and the anesthesiologist covering the role of the perioperative (transplant) physician.
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Affiliation(s)
| | - Laura Petrò
- ANRI1 - Emergency and Intensive Care, ASST Ospedale Giovanni XXIII, Bergamo, Italy; ASST Papa Giovanni XXII, Piazza MSO 1, 24100 Bergamo, Italy
| | - Elisabetta Cerutti
- Anestesia e Rianimazione dei Trapianti e Chirurgia Maggiore, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60020, Ancona, Italy; Azienda Ospedaliero Universitaria "Ospedali Riuniti", Via Conca 71, 60020, Ancona, Italy
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10
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Deng Y, Hui Y, Cui B, Xie W, Sun C. Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis! Liver Int 2023; 43:1629-1643. [PMID: 37288711 DOI: 10.1111/liv.15639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
Frailty corresponds to an emerging construct in the hepatology which is originally introduced as a validated geriatric syndrome regarding increased vulnerability to pathophysiological stressors. As for patients with cirrhosis, the presence of frailty is indicative of debilitating conditions that subjects are prone to deleterious acute insults and have difficulties to restore even if the underlying liver function partially returned to normal levels. Since this conceptual development, a variety of tools assessing frailty have been proposed and evaluated in the context of cirrhosis. A recent performance-based metric for frailty, designated as Liver Frailty Index, has broadly been applied in patients with cirrhosis and exhibited acceptable predictive ability in relation to disease progression, mortality and hospitalization. However, those functional tests measuring frailty may be impossible to perform in circumstance that patients are critically ill or undergoing detrimental events. An interesting modality indicates the use of alternative tests to evaluate frailty, which may be more adaptable and of choice for specific subgroups. The interrelation between frailty and various cirrhosis-associated pathological entities is of clinical importance and implication. Noticeably, it is imperative to clarify these complex linkages to highlight novel therapeutic targets or interventional endpoints. The efficient and effective management of frailty is still challenging, but many attempts have been made to overcome barriers of affordability and availability. Some clinical trials on small scale revealed that home-based exercise and individualized nutrition therapy show benefits in patients with cirrhosis, and high adherence to the treatment regimen may direct better efficacy and performance.
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Affiliation(s)
- You Deng
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Binxin Cui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Wen Xie
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
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11
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Mangana del Rio T, Sacleux SC, Vionnet J, Ichaï P, Denys A, Schneider A, Coilly A, Fraga M, Wetzel A, Koerfer J, Chiche JD, Saliba F, Moradpour D, Becce F, Artru F. Body composition and short-term mortality in patients critically ill with acute-on-chronic liver failure. JHEP Rep 2023; 5:100758. [PMID: 37547185 PMCID: PMC10403365 DOI: 10.1016/j.jhepr.2023.100758] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/14/2023] [Accepted: 03/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background & Aims Body composition is sex dependent and associated with an increased mortality risk in patients with cirrhosis. We evaluated whether it was also associated with short-term mortality in patients critically ill with acute-on-chronic liver failure (ACLF). Patients and methods We retrospectively included all patients with cirrhosis and ACLF hospitalised in the intensive care unit (ICU) of Lausanne University Hospital between 2010 and 2019 for whom an abdominal computed tomography (CT) scan performed ±7 days from admission was available. Patients from the ICU of Paul Brousse University Hospital admitted between 2017 and 2020 served as an external cohort. All body composition parameters at the third lumbar vertebral level (L3) were quantified using a deep learning-based method. Results In total, 192 patients from Lausanne were included. Median age was 62 years and 28-day survival rate was 58.2%. In males, variables independently associated with 28-day mortality on days 1 and 3 were Chronic Liver Failure Consortium (CLIF-C) ACLF-lactate and sarcopenia. In females, CLIF-C ACLF-lactate on days 1 and 3 was the only predictor of 28-day survival. We derived two scores combining sarcopenia and the CLIF-C ACLF-lactate score on days 1 and 3, with area under the receiver operating characteristic outperforming the CLIF-C ACLF-lactate score alone in male but not in female patients. Comparable results were found in the external cohort of 58 patients and supported the sex specificity of the performance of the model. Patients with sarcopenia had increased risks of invasive fungal infection and renal replacement therapy. Conclusion Sarcopenia was associated with 28-day mortality in male but not in female patients critically ill with ACLF. Although screening for sarcopenia could impact the management of male patients, further studies are needed in female cohorts to investigate whether other body composition parameters are associated with outcomes. Impact and implications Body composition, easily assessed by CT, is altered in patients with cirrhosis and associated with outcome; it has never been investigated in patients critically ill with ACLF. The results of the present study, underlining the benefit of sarcopenia evaluation to improve prognosis prediction in males critically ill with ACLF, are of importance for physicians managing such patients to optimise the decision-making process toward continued treatment, liver transplantation, or limitation of care. In a wider sense, besides the number and course of organ failures, the results recall the weight of the general condition of males with ACLF at admission to ICU. In females critically ill with ACLF, in analyses limited by the sample size, none of the body composition parameters was associated with short-term mortality independently of organ failures; this suggests that the number and course of organ failures are the main determinant of mortality in these patients.
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Affiliation(s)
- Thomas Mangana del Rio
- Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sophie-Caroline Sacleux
- Liver Intensive Care Unit, AP-HP Paul Brousse Hospital, University Paris SACLAY, INSERM Unit N°1193, Villejuif, France
| | - Julien Vionnet
- Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Transplantation Centre, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Ichaï
- Liver Intensive Care Unit, AP-HP Paul Brousse Hospital, University Paris SACLAY, INSERM Unit N°1193, Villejuif, France
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antoine Schneider
- Division of Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Audrey Coilly
- Liver Intensive Care Unit, AP-HP Paul Brousse Hospital, University Paris SACLAY, INSERM Unit N°1193, Villejuif, France
| | - Montserrat Fraga
- Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Wetzel
- Data Science, Lausanne University Hospital, Lausanne, Switzerland
| | - Joachim Koerfer
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Daniel Chiche
- Division of Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Faouzi Saliba
- Liver Intensive Care Unit, AP-HP Paul Brousse Hospital, University Paris SACLAY, INSERM Unit N°1193, Villejuif, France
| | - Darius Moradpour
- Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Florent Artru
- Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Liver Studies, King’s College Hospital, London, UK
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12
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Wang M, Shui AM, Barry F, Verna E, Kent D, Yao F, Seetharaman S, Berry K, Grubbs RK, George G, Huang CY, Duarte-Rojo A, Lai JC. The tele-liver frailty index (TeLeFI): development of a novel frailty tool in patients with cirrhosis via telemedicine. Am J Transplant 2023; 23:966-975. [PMID: 37061188 PMCID: PMC10330470 DOI: 10.1016/j.ajt.2023.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
Frailty is a critical determinant of outcomes in cirrhosis patients. The increasing use of telemedicine has created an unmet need for virtual frailty assessment. We aimed to develop a telemedicine-enabled frailty tool (tele-liver frailty index). Adults with cirrhosis in the liver transplant setting underwent ambulatory frailty testing with the liver frailty index (LFI) in-person, then virtual administration of (1) validated surveys (eg, SARC-F and Duke Activity Status Index [DASI]), (2) chair stands, and (3) balance. Two models were selected and internally validated for predicting LFI ≥4.4 using: (1) Bayesian information criterion (BIC), (2) C-statistics, and (3) ease of use. Of 145 patients, the median (interquartile range) LFI was 3.7 (3.3-4.2); 15% were frail. Frail (vs not frail) patients reported significantly greater impairment on all virtually assessed instruments. We selected 2 parsimonious models: (1) DASI + chair/bed transfer (SARC-F) (BIC 255, C-statistics 0.78), and (2) DASI + chair/bed transfer (SARC-F) + virtually assessed chair stands (BIC 244, C-statistics 0.79). Both models had high C-statistics (0.76-0.78) for predicting frailty. In conclusion, the tele-liver frailty index is a novel tool to screen frailty in liver transplant patients via telemedicine pragmatically and may be used to identify patients who require in-person frailty assessment, more frequent follow-up, or frailty intervention.
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Affiliation(s)
- Melinda Wang
- Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Amy M Shui
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
| | - Fawzy Barry
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Elizabeth Verna
- Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Dorothea Kent
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Frederick Yao
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Srilakshmi Seetharaman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Kacey Berry
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Rachel K Grubbs
- Division Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Geena George
- Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
| | - Andres Duarte-Rojo
- Division Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
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13
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Murata K, Kaji K, Nishimura N, Enomoto M, Fujimoto Y, Takeda S, Tsuji Y, Fujinaga Y, Takaya H, Kawaratani H, Namisaki T, Akahane T, Yoshiji H. Rifaximin enhances the L‑carnitine‑mediated preventive effects on skeletal muscle atrophy in cirrhotic rats by modulating the gut‑liver‑muscle axis. Int J Mol Med 2022; 50:101. [PMID: 35686541 PMCID: PMC9242656 DOI: 10.3892/ijmm.2022.5157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
Abstract
The gut‑liver‑muscle axis is associated with the development of sarcopenia in liver cirrhosis. The present study aimed to illustrate the combined effects of rifaximin and L‑carnitine on skeletal muscle atrophy in cirrhotic rats with steatohepatitis. For this purpose, a total of 344 Fischer rats were fed a choline‑deficient L‑amino acid‑defined (CDAA) diet with the daily oral administration of rifaximin (100 mg/kg) and/or L‑carnitine (200 mg/kg), and measurements of psoas muscle mass index and forelimb grip strength were performed. After feeding for 12 weeks, blood samples, and liver, ileum and gastrocnemius muscle tissues were harvested. The effects of L‑carnitine on rat myocytes were assessed using in vitro assays. Treatment with rifaximin attenuated hyperammonemia and liver fibrosis in the CDAA‑fed rats. Moreover, it improved intestinal permeability with the restoration of tight junction proteins and suppressed the lipopolysaccharide (LPS)‑mediated hepatic macrophage activation and pro‑inflammatory response. In addition, rifaximin prevented skeletal muscle mass atrophy and weakness by decreasing intramuscular myostatin and pro‑inflammatory cytokine levels. Moreover, rifaximin synergistically enhanced the L‑carnitine‑mediated improvement of skeletal muscle wasting by promoting the production of insulin‑like growth factor‑1 and mitochondrial biogenesis, resulting in the inhibition of the ubiquitin‑proteasome system (UPS). The in vitro assays revealed that L‑carnitine directly attenuated the impairment of mitochondrial biogenesis, thereby inhibiting the UPS in rat myocytes that were stimulated with LPS or tumor necrosis factor‑α. On the whole, the present study demonstrates that the combination of rifaximin with L‑carnitine may provide a clinical benefit for liver cirrhosis‑related sarcopenia.
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Affiliation(s)
- Koji Murata
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Masahide Enomoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Yuki Fujimoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Soichi Takeda
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara, Nara 634‑8521, Japan
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14
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Mauro E, Diaz JM, Garcia-Olveira L, Spina JC, Savluk L, Zalazar F, Saidman J, De Santibañes M, Pekolj J, De Santibañes E, Crespo G, Abraldes JG, Gadano A. Sarcopenia HIBA score predicts sarcopenia and mortality in patients on the liver transplant waiting list. Hepatol Commun 2022; 6:1699-1710. [PMID: 35238487 PMCID: PMC9234615 DOI: 10.1002/hep4.1919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/29/2021] [Accepted: 01/22/2022] [Indexed: 12/14/2022] Open
Abstract
Sarcopenia is a prevalent condition that predicts prognosis in patients awaiting liver transplantation (LT). The gold standard for the diagnosis of sarcopenia is the assessment of the muscular area at L3 with computed tomography (CT) scan (skeletal muscle index [SMI]), but the routine use of CT scan is limited in clinical practice. Thus, we designed a single-center observational study aimed to evaluate the clinical factors associated with the presence of sarcopenia by SMI, and to build a score capable of predicting or excluding the presence of sarcopenia in patients on the LT waiting list (WL). Binary logistic regression analysis was performed to establish the factors independently associated with sarcopenia, and the Sarcopenia Hospital Italiano de Buenos Aires (HIBA) score was built from the resulting model after internal validation analysis by bootstrapping and correction for optimism. The predictive capability of mortality on the WL was evaluated with competing risk regression analysis. A total of 215 patients with cirrhosis on the LT WL were included. The independent factors associated with the presence of sarcopenia were male sex (odds ratio [OR]: 6.09, p < 0.001), body mass index (OR: 0.74, p < 0.001), Child Pugh (OR: 1.44, p < 0.001), and the ratio creatinine/Cystatin C (OR: 0.03, p = 0.007). The Sarcopenia HIBA score constructed with these variables showed an area under the curve of 0.862. During follow-up, 77 (36%) patients underwent LT, 46 (21%) died, and 92 (43%) remained alive. After adjusting for Model for End-Stage Liver Disease-Sodium, Sarcopenia HIBA score was an independent predictor of WL mortality (subhazard ratio: 1.19; 95% confidence interval 1.01-1.40; p = 0.042). Sarcopenia HIBA score is an easy-to-use, objective, and reliable diagnostic and predictive tool that can be useful to improve the prognostic evaluation and allow identifying a group of patients with a higher risk of death while awaiting LT.
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Affiliation(s)
- Ezequiel Mauro
- Liver UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.,HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Juan Manuel Diaz
- Liver UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | - Juan Carlos Spina
- HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.,Radiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Lorena Savluk
- HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.,Radiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Fernanda Zalazar
- Liver UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Julia Saidman
- Radiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Martin De Santibañes
- HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Juan Pekolj
- HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | - Gonzalo Crespo
- Liver Transplant UnitLiver UnitIDIBAPSCIBERehdHospital ClínicUniversity of BarcelonaBarcelonaSpain
| | - Juan G Abraldes
- Division of GastroenterologyUniversity of AlbertaCEGIIREdmontonAlbertaCanada
| | - Adrían Gadano
- Liver UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.,HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
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15
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Serper M, Asrani S, VanWagner L, Reese PP, Kim M, Wolf MS. Redefining Success After Liver Transplantation: From Mortality Toward Function and Fulfillment. Liver Transpl 2022; 28:304-313. [PMID: 34608746 DOI: 10.1002/lt.26325] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/31/2021] [Accepted: 09/29/2021] [Indexed: 01/13/2023]
Abstract
Liver transplantation (LT), the only cure for end-stage liver disease, is a lifesaving, costly, and limited resource. LT recipients (LTRs) are aging with an increasing burden of medical comorbidities. Patient and graft survival rates exceed 70% at 5 years; however, patient-centered health outcomes beyond survival have received relatively little attention. LTRs must have strong self-management skills to navigate health systems, adhere to clinical monitoring, and take complex, multidrug regimens. All of these tasks require formidable cognitive abilities for active learning and problem solving. Yet, LTRs are at higher risk for impaired cognition as a result of the high prevalence of pretransplant hepatic encephalopathy, multiple chronic conditions, alcohol use, physical frailty, sarcopenia, and older age. Cognitive impairment after transplant may persist and has been causally linked to poor self-management skills, worse physical function, and inferior health outcomes in other health care settings, yet its impact after LT is largely unknown. There is a need to study potentially modifiable, posttransplant targets including caregiver support, physical activity, sleep, and treatment adherence to inform future health system responses to promote the long-term health and well-being of LTRs. Prospective, longitudinal data collection that encompasses key sociodemographic, cognitive-behavioral, psychosocial, and medical factors is needed to improve risk prediction and better inform patient and caregiver expectations. Interventions with proactive monitoring, reducing medical complexity, and improved care coordination can be tailored to optimize posttransplant care. We propose a research agenda focused on understudied, potentially modifiable risk factors to improve the long-term health of LTRs. Our conceptual model accounts for cognitive function, caregiver and patient self-management skills, health behaviors, and patient-centered outcomes beyond mortality. We propose actionable health-system, patient, and caregiver-directed interventions to fill knowledge gaps and improve outcomes.
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Affiliation(s)
- Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | | | - Lisa VanWagner
- Division of Gastroenterology & Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Peter P Reese
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA.,Division of Renal Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Minjee Kim
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S Wolf
- Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
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16
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He K, Xia Q. Should sarcopenia be an additional factor enough to affect liver transplant decision-making? Hepatobiliary Surg Nutr 2021; 10:884-886. [PMID: 35004962 PMCID: PMC8683919 DOI: 10.21037/hbsn-2021-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/23/2021] [Indexed: 01/25/2024]
Affiliation(s)
- Kang He
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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17
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is a major public health crisis affecting approximately 25% of the world's population. The spectrum of NAFLD ranges from bland steatosis to steatohepatitis with fibrosis; eventual development of cirrhosis in a subgroup of patients now represents the leading indication for liver transplant in women and in individuals older than 65. The development of noninvasive liver disease assessment tools has led to substantial progress in the diagnosis of NAFLD. Patients with NAFLD are at increased risk of cardiometabolic disease, which should therefore be an important part of the therapeutic approach. This review focuses on diagnosis and risk stratification of NAFLD across the full spectrum of disease, including important considerations in the approach to patients with cirrhosis. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Yedidya Saiman
- Department of Medicine, Section of Hepatology, Lewis Katz School of Medicine at Temple University, Temple University Hospital, Philadelphia, Pennsylvania 19140
| | - Andres Duarte-Rojo
- Division of Gastroenterology, Hepatology and Nutrition; Starzl Transplantation Institute; and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
| | - Mary E Rinella
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA;
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