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Zhang K, Liu Y, Du P, Ou Y, Wu Y, Liu G. Impact of Adding Bedside Cycling to Intensive Care Unit Rehabilitation on Physical Function and Length of Stay After Liver Transplantation: A Randomized Controlled Trial. Transplant Proc 2024; 56:1766-1773. [PMID: 39242315 DOI: 10.1016/j.transproceed.2024.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 04/27/2024] [Accepted: 08/24/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To assess the effectiveness of early bedside cycling training in enhancing recovery among patients following liver transplantation. METHODS A total of 64 patients who underwent liver transplantation were randomly assigned to either an experimental group or a control group, with 32 patients in each group. Patients in the control group received routine rehabilitation training after postoperative consciousness recovery and tracheal extubation. The experimental group received supplemental lower limb bedside cycling training in addition to the routine rehabilitation. Differences in physical function, length of intensive care unit, and hospital stays were compared between the two groups. RESULTS The experimental group showed significantly greater improvements in physical function, such as activities of daily living scores and Berg Balance Scale scores, compared to the control group (P < .05). While the experimental group also exhibited decreased length of intensive care unit and hospital stays compared to the control group, these differences lacked statistical significance. CONCLUSION Early bedside cycling training contributes to enhanced physical function, such as balance function and activities of daily living, among patients undergoing liver transplantation.
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Affiliation(s)
- Kangning Zhang
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Rehabilitation Medicine, Shanghai Geriatric Medical Center, Shanghai, China; Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Yuanyuan Liu
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Rehabilitation Medicine, Shanghai Geriatric Medical Center, Shanghai, China; Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Peng Du
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Yuqi Ou
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Yiming Wu
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Rehabilitation Medicine, Shanghai Geriatric Medical Center, Shanghai, China; Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Guanghua Liu
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China.
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2
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Taskin Gurel B, Vardar Yagli N, Calik Kutukcu E, Saglam M, Inal Ince D, Arikan H, Dogrul AB, Abbasoglu O. Long-Term Declines in Physical Fitness and Physical Activity for Individuals With Post-Liver Transplantation Compared to Healthy Controls. Percept Mot Skills 2023; 130:2450-2464. [PMID: 37643424 DOI: 10.1177/00315125231199662] [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] [Indexed: 08/31/2023]
Abstract
Functional changes are essential determinants of mortality and morbidity in individuals with chronic liver disease. However, there is limited information about whether these changes persist long-term after liver transplantation (LT). We aimed to compare physical fitness, physical activity, balance, kinesiophobia, and fatigue between patients with LT and healthy controls. All participants underwent evaluation with the Senior Fitness Test (SFT) for exercise capacity and physical fitness, the International Physical Activity Questionnaire (IPAQ) for physical activity, the Timed Up-and-Go Test (TUG) and the Berg Balance Scale (BBS) for balance, the Tampa Scale for Kinesiophobia (TSK) for kinesiophobia, and the Fatigue Severity Scale (FSS) and Fatigue Impact Scale (FIS) for fatigue. We studied 16 persons with LT (M age = 40.56, SD = 15.73 years; M time since LT = 66.81, SD = 72.05 months) and 16 control participants (M age = 39.87, SD = 13.98 years). Compared to controls, participants with LT showed significantly poorer performance on the SFT components assessing upper and lower body strength, aerobic endurance, agility, and dynamic balance (p < .001 for all), significantly lower IPAQ physical activity scores (p = .002) and BBS score (p = .017), and significantly higher TUG time (p < .001) and TSK, FSS, and FIS scores (p = .001, p = .001, and p = .004, respectively). Individuals with post-LT had lower exercise capacity, physical fitness, balance, and physical activity, and higher kinesiophobia and fatigue levels in the long-term compared to their peers. Future studies should focus on frailty in individuals in the long term after LT.
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Affiliation(s)
- Bilge Taskin Gurel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
| | - Naciye Vardar Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ebru Calik Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hulya Arikan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ahmet Bulent Dogrul
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Osman Abbasoglu
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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3
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Yoshioka Y, Oshima Y, Hata K, Sato S, Hamada R, Sato T, Kaido T, Munekage F, Ito T, Ikeguchi R, Uemoto S, Hatano E, Matsuda S. Factors associated with early postoperative exercise tolerance after living-donor liver transplantation. Clin Transplant 2022; 36:e14800. [PMID: 35993374 DOI: 10.1111/ctr.14800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/20/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Physical dysfunction, including exercise intolerance, is a major factor for delayed societal reintegration for patients who underwent living-donor liver transplantation (LDLT). However, what may contribute to early postoperative physical function is not well known. The purpose of this study is to elucidate the perioperative factors affecting early posttransplant exercise intolerance. METHODS 103 consecutive patients who underwent LDLT were enrolled, and 68 patients were retrospectively analyzed. We examined the relationship between postoperative exercise tolerance evaluated by a 6-minute walking distance (6MWD) at discharge after surgery and demographic data, surgical information, preoperative physical function, clinical course, and the postoperative decline in physical function with univariate and multivariate analyses. RESULTS Almost all patients were discharged within 3 months after surgery. The postoperative 6MWD was 408 ± 94 m (68 [61-84]% of the predicted value), and patients who had a low %6MWD at discharge had significantly lower preoperative physical function than patients who had a high %6MWD at discharge (grip strength: 29.8 ± 8.9 kgf vs. 23.0 ± 8.8 kgf, P < .01, knee extensor strength: 138.9 ± 59.4 Nm vs. 95.2 ± 42.1 Nm, P < .01). Multivariate analysis revealed that preoperative knee extensor strength (standardized β = 0.35, P < .01) and first postoperative walking day (standardized β = -0.22, P = .04) were independently associated with the postoperative %6MWD. CONCLUSION These results suggest that maintaining preoperative muscle strength and allowing for early postoperative mobilization might help to enhance the recovery of physical function and facilitate the patient's social reintegration after LDLT.
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Affiliation(s)
- Yuji Yoshioka
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Yohei Oshima
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Koichiro Hata
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Sato
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.,Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Tatsuya Sato
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.,Health Science, Graduate School of Health Science, Kio University, Nara, Japan
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Gastroenterological and General Surgery, St. Luke's International University Hospital, Tokyo, Japan
| | - Fumiaki Munekage
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ito
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Shiga University of Medical Science, Otsu, Japan
| | - Etsuro Hatano
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
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Ergene T, Karadibak D, Polat KY. Fatigue and Physiotherapy In Liver Transplant Recipients Fatigue and Physiotherapy. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2019. [DOI: 10.33808/clinexphealthsci.599730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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5
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Clinical Relevance of a Balance Training Program on Liver Transplant Patients. A Randomized Controlled Trial. Transplantation 2019; 103:965-972. [DOI: 10.1097/tp.0000000000002415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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6
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Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Bischoff SC. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 2019; 38:485-521. [PMID: 30712783 DOI: 10.1016/j.clnu.2018.12.022] [Citation(s) in RCA: 345] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023]
Abstract
This update of evidence-based guidelines (GL) aims to translate current evidence and expert opinion into recommendations for multidisciplinary teams responsible for the optimal nutritional and metabolic management of adult patients with liver disease. The GL was commissioned and financially supported by ESPEN. Members of the guideline group were selected by ESPEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. A total of 85 recommendations were made for the nutritional and metabolic management of patients with acute liver failure, severe alcoholic steatohepatitis, non-alcoholic fatty liver disease, liver cirrhosis, liver surgery and transplantation as well as nutrition associated liver injury distinct from fatty liver disease. The recommendations are preceded by statements covering current knowledge of the underlying pathophysiology and pathobiochemistry as well as pertinent methods for the assessment of nutritional status and body composition.
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Affiliation(s)
- Mathias Plauth
- Department of Internal Medicine, Municipal Hospital of Dessau, Dessau, Germany.
| | - William Bernal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Srinivasan Dasarathy
- Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Manuela Merli
- Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Lindsay D Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Tatjana Schütz
- IFB Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Stephan C Bischoff
- Department for Clinical Nutrition, University of Hohenheim, Stuttgart, Germany
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7
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Brustia R, Savier E, Scatton O. Physical exercise in cirrhotic patients: Towards prehabilitation on waiting list for liver transplantation. A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2018; 42:205-215. [PMID: 29162460 DOI: 10.1016/j.clinre.2017.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/06/2017] [Accepted: 09/19/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early survival after Liver Transplantation (LT) is reduced among sarcopenic patients. Despite, Adapted Physical Activity (APA) before LT is rarely proposed for the risk to impair portal hypertension and its resulting complications. OBJECTIVES To assess the effects of APA program in adults affected by End Stage Liver Disease (ESLD) on hospital stay, 1-year mortality and morbidity after LT, adverse events (Primary outcomes). Secondary outcomes were changes in VO2 peak, muscle morphology, 6minutes walking distance test (6MWD), Body Mass Index (BMI), MELD, CHILD score and Hepatic Venous Pressure Gradient (HVPG). SEARCH METHODS MEDLINE, EMBASE, Google Scholar and the Cochrane Library database were explored for randomized clinical trials (RCT). DATA COLLECTION AND ANALYSIS Data were collected by one review author on the type of study, participants, treatments used for primary and secondary outcomes. Review Manager 5.2 was used for the analysis. MAIN RESULTS Four RCT with 81 patients were included. Primary outcomes: no severe adverse event was observed, but no published data were available on hospital stay or mortality after LT. SECONDARY OUTCOMES CHILD, MELD and BMI were not worsened by physical activity. No significant muscle diameter, 6MWD and VO2 peak changes were observed after exercise. Significant reduction in HVPG in the treatment group was observed in a single study (MD-2.5mmHg; 95%CI [-04.76, -0.24]; P=0.03). AUTHORS' CONCLUSIONS Knowledge in this field is still at an early stage. Evidence derived from small trials of medium quality on ESLD patients suggests that APA is safe, without increasing portal hypertension. Further research is very likely to have an important impact on our confidence in the intervention effect.
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Affiliation(s)
- Raffaele Brustia
- Department of hepatobiliary and liver transplantation surgery, hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, France; Université Pierre-et-Marie-Curie, 75005 Paris, France
| | - Eric Savier
- Department of hepatobiliary and liver transplantation surgery, hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, France
| | - Olivier Scatton
- Department of hepatobiliary and liver transplantation surgery, hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, France; Université Pierre-et-Marie-Curie, 75005 Paris, France.
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8
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Walcott-Sapp S, Billingsley KG. Preoperative optimization for major hepatic resection. Langenbecks Arch Surg 2017; 403:23-35. [PMID: 29150719 DOI: 10.1007/s00423-017-1638-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Major hepatic resections are performed for primary hepatobiliary malignancies, metastatic disease, and benign lesions. Patients with chronic liver disease, including cirrhosis and steatosis, are at an elevated risk of malnutrition and impaired strength and exercise capacity, deficits which cause increased risk of postoperative complications and mortality. The aims of this report are to discuss the pathophysiology of changes in nutrition, exercise capacity, and muscle strength in patient populations likely to require major hepatectomy, and review recommendations for preoperative evaluation and optimization. METHODS Nutritional and functional impairment in preoperative hepatectomy patients, especially those with underlying liver disease, have a complex and multifactorial physiologic basis that is not completely understood. RESULTS Recognition of malnutrition and compromised strength and exercise tolerance preoperatively can be difficult, but is critical in providing the opportunity to intervene prior to major hepatic resection and potentially improve postoperative outcomes. There is promising data on a variety of nutritional strategies to ensure adequate intake of calories, proteins, vitamins, and minerals in patients with cirrhosis and reduce liver size and degree of fatty infiltration in patients with hepatic steatosis. Emerging evidence supports structured exercise programs to improve exercise tolerance and counteract muscle wasting. CONCLUSIONS The importance of nutrition and functional status in patients indicated for major liver resection is apparent, and emerging evidence supports structured preoperative preparation programs involving nutritional intervention and exercise training. Further research is needed in this field to develop optimal protocols to evaluate and treat this heterogeneous cohort of patients.
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Affiliation(s)
- Sarah Walcott-Sapp
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code: L223, Portland, OR, 97239, USA.
| | - Kevin G Billingsley
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code: L223, Portland, OR, 97239, USA
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9
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Moya-Nájera D, Moya-Herraiz Á, Compte-Torrero L, Hervás D, Borreani S, Calatayud J, Berenguer M, Colado JC. Combined resistance and endurance training at a moderate-to-high intensity improves physical condition and quality of life in liver transplant patients. Liver Transpl 2017; 23:1273-1281. [PMID: 28749550 DOI: 10.1002/lt.24827] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/08/2017] [Accepted: 07/14/2017] [Indexed: 02/07/2023]
Abstract
Although currently moderate and high intensity concurrent physical exercise is prescribed in populations with special needs due to its greater effect on physical condition and health-related quality of life (HRQOL), there are no data in the liver transplantation (LT) setting. The aim of this study is to evaluate changes in maximal strength, aerobic capacity, body composition, liver function, and HRQOL in LT patients after a moderate-to-high intensity combined resistance-endurance training. Six months after LT, 54 patients were randomized into 2 groups: intervention group (IG) and control group (CG). A total of 50 patients completed the study with repeat testing at 6 and 12 months after LT. The IG completed a 6-month exercise training program, consisting of exercising 2 days for 24 weeks in the hospital facilities, whereas the CG followed usual care recommendations. Patients completed a 5-multijoint exercise circuit with elastic bands involving the major muscle groups. The effects of the concurrent training program on maximal oxygen consumption, overall and regional maximal strength, body composition, liver function, and HRQOL were analyzed. The IG showed a significant improvement (P < 0.05) in outcome measurements compared with the CG in aerobic capacity, hip extension, elbow flexion, overall maximal strength, physical functioning, and vitality of HRQOL, whereas no changes were observed in body composition and liver function tests. In conclusion, this is the first study that combines supervised resistance and aerobic training performed at moderate-to-high intensity in LT recipients. It results in significant improvements in aerobic capacity, maximal strength, and HRQOL. Liver Transplantation 23 1273-1281 2017 AASLD.
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Affiliation(s)
- Diego Moya-Nájera
- Research Unit in Sport and Health, University of Valencia, Valencia, Spain
| | | | | | - David Hervás
- Pneumology Unit, Hospital La Fe, Valencia, Spain
| | - Sebastien Borreani
- Research Unit in Sport and Health, University of Valencia, Valencia, Spain
| | - Joaquin Calatayud
- Research Unit in Sport and Health, University of Valencia, Valencia, Spain
| | - Marina Berenguer
- Department of Medicine, University of Valencia, Valencia, Spain.,HPB and Transplant Unit, Hospital La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Juan C Colado
- Research Unit in Sport and Health, University of Valencia, Valencia, Spain.,Research Group in Prevention and Health in Exercise and Sport, University of Valencia, Valencia, Spain
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10
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Sundaram V, Lim J, Tholey DM, Iriana S, Kim I, Manne V, Nissen NN, Klein AS, Tran TT, Ayoub WS, Schlansky B. The Braden Scale, A standard tool for assessing pressure ulcer risk, predicts early outcomes after liver transplantation. Liver Transpl 2017; 23:1153-1160. [PMID: 28512923 DOI: 10.1002/lt.24789] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/29/2017] [Accepted: 05/07/2017] [Indexed: 12/13/2022]
Abstract
The Braden Scale is a standardized tool to assess pressure ulcer risk that is reported for all hospitalized patients in the United States per requirements of the Center for Medicare and Medicaid Services. Previous data have shown the Braden Scale can predict both frailty and mortality risk in patients with decompensated cirrhosis. Our aim was to evaluate the association of the Braden Scale score with short-term outcomes after liver transplantation (LT). We performed a retrospective cohort study of deceased donor LT recipients at 2 centers and categorized them according to the Braden Scale at hospital admission as low (>18), moderate (16-18), or high risk (<16) for pressure ulcer. We created logistic and Poisson multiple regression models to evaluate the association of Braden Scale category with in-hospital and 90-day mortality, length of stay (LOS), nonambulatory status at discharge, and discharge to a rehabilitation facility. Of 341 patients studied, 213 (62.5%) were low risk, 59 (17.3%) were moderate risk, and 69 (20.2%) were high risk. Moderate- and high-risk patients had a greater likelihood for prolonged LOS, nonambulatory status, and discharge to a rehabilitation facility, as compared with low-risk patients. High-risk patients additionally had increased risk for in-hospital and 90-day mortality after LT. Multiple regression modeling demonstrated that high-risk Braden Scale score was associated with prolonged LOS (IRR, 1.56; 95% confidence interval [CI], 1.47-1.65), nonambulatory status at discharge (odds ratio [OR], 4.15; 95% CI, 1.77-9.71), and discharge to a rehabilitation facility (OR, 5.51; 95% CI, 2.57-11.80). In conclusion, the Braden Scale, which is currently assessed in all hospitalized patients in the United States, independently predicted early disability-related outcomes and greater LOS after LT. Liver Transplantation 23 1153-1160 2017 AASLD.
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Affiliation(s)
- Vinay Sundaram
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jane Lim
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA
| | - Danielle M Tholey
- Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR
| | - Sentia Iriana
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA
| | - Irene Kim
- Department of Surgery, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Vignan Manne
- Department of Medicine, Akron General Hospital, Akron, OH
| | - Nicholas N Nissen
- Department of Surgery, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Andrew S Klein
- Department of Surgery, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tram T Tran
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Walid S Ayoub
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Barry Schlansky
- Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR
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11
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Monte da Silva AG, deA Roza Aguiar B, Chiavegato LD. Association Between Dyspnea and Severity of Liver Disease in Patients in the Pre-transplantation Period-A Pilot Study. Transplant Proc 2016; 48:2328-2332. [PMID: 27742290 DOI: 10.1016/j.transproceed.2016.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Liver transplantation is indicated at the end stage of chronic liver failure, and severity of disease will determine the precocity of this happening. At this stage, the presence of chronic dyspnea is one of several manifestations of progression of the disease, which leads the patient to inactivity. A rehabilitation program can positively influence the evolution of liver transplant recipients. The objective of this study was to establish an association between the perception of dyspnea and the severity of liver disease in patients at a single center of a Brazilian liver pre-transplantation clinic. METHODS Measurements were performed at a liver pre-transplantation clinic. The severity of liver disease was assessed with the use of the Model for End-Stage Liver Disease (MELD) score, and dyspnea was assessed with the use of a modified Medical Research Council scale of dyspnea (mMRC). RESULTS Men had a higher prevalence of viral hepatitis. Dyspnea was reported only during intense exercise. Duration of disease and MELD score showed medians of 49 months and 20, respectively. CONCLUSIONS We found no correlation between mMRC and the MELD score. In addition, no correlation was found between duration of disease and MELD score or mMRC.
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Affiliation(s)
| | | | - L D Chiavegato
- Universidade Federal de São Paulo, São Paulo, Brazil; Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
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12
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13
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Limongi V, Dos Santos DC, Oliveira da Silva AMD, Boin IDFSF, Stucchi RSB. Exercise manual for liver disease patients. World J Transplant 2016; 6:429-436. [PMID: 27358789 PMCID: PMC4919748 DOI: 10.5500/wjt.v6.i2.429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/18/2016] [Accepted: 04/18/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To increase inspiratory muscle strength and improve the quality of life of candidates for liver transplantation.
METHODS: Twenty-three candidates for liver transplantation participated in the control group and 14 made up the intervention group. The control group consisted of 18 men and 5 women, body mass index (BMI) 27.3 ± 4.5 kg/m2 and Model for End-Stage Liver Disease (MELD) 18.2 ± 6.1. The intervention group consisted of 11 men and 3 women, BMI 28.6 ± 5.4 kg/m2 and MELD 18 ± 4.5. The presence or absence of ascites was identified in the first patient evaluation and after three months. We evaluated maximal inspiratory pressure (MIP) and maximal expiratory pressure, spirometry, root mean square (RMS) of diaphragm and rectus abdominis, and the quality of life. The exercises were performed daily by patients at home for three months and were supervised at distance monthly. The manual consisted of diaphragmatic breathing exercises, diaphragmatic isometric exercise, Threshold IMT®, lifting upper limbs with a bat and strengthening the abdomen.
RESULTS: There was significant difference (P = 0.01) between the first (initial) and the third month (final) MIP in the control group and in the intervention group, but there was no difference (P = 0.45) between the groups. The RMS of the diaphragm was lower (P = 0.001) and the functional capacity was higher (P = 0.006) in the intervention group compared to the control. The general health and mental health domains received higher scores after three months in the control group (P = 0.01) and the intervention group (P = 0.004), but there was no significant difference between them. The comparison between the presence of initial ascites with the presence of ascites was performed after three months in the control group (P = 0.083) and intervention group (P = 0.31). There was no significant difference, in relation to the presence of ascites after three months between groups (P = 0.21). In the intervention group, patients with ascites at the end of the time period had decreased scores on the social aspects SF-36 domain (P = 0.023) compared to those who had no ascites.
CONCLUSION: The proposed exercises provide an increase in the inspiratory muscle strength and improve functional capacity, consequently bettering the quality of life of liver disease patients.
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14
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Román E, García-Galcerán C, Torrades T, Herrera S, Marín A, Doñate M, Alvarado-Tapias E, Malouf J, Nácher L, Serra-Grima R, Guarner C, Cordoba J, Soriano G. Effects of an Exercise Programme on Functional Capacity, Body Composition and Risk of Falls in Patients with Cirrhosis: A Randomized Clinical Trial. PLoS One 2016; 11:e0151652. [PMID: 27011355 PMCID: PMC4807034 DOI: 10.1371/journal.pone.0151652] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/02/2016] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED Patients with cirrhosis often have functional limitations, decreased muscle mass, and a high risk of falls. These variables could improve with exercise. The aim was to study the effects of moderate exercise on functional capacity, body composition and risk of falls in patients with cirrhosis. Twenty-three cirrhotic patients were randomized to an exercise programme (n = 14) or to a relaxation programme (n = 9). Both programmes consisted of a one-hour session 3 days a week for 12 weeks. At the beginning and end of the study, we measured functional capacity using the cardiopulmonary exercise test, evaluated body composition using anthropometry and dual energy X-ray absorptiometry, and estimated risk of falls using the Timed Up&Go test. In the exercise group, cardiopulmonary exercise test showed an increase in total effort time (p<0.001) and ventilatory anaerobic threshold time (p = 0.009). Upper thigh circumference increased and mid-arm and mid-thigh skinfold thickness decreased. Dual energy X-ray absorptiometry showed a decrease in fat body mass (-0.94 kg, 95%CI -0.48 to -1.41, p = 0.003) and an increase in lean body mass (1.05 kg, 95%CI 0.27 to 1.82, p = 0.01), lean appendicular mass (0.38 kg, 95%CI 0.06 to 0.69, p = 0.03) and lean leg mass (0.34 kg, 95%CI 0.10 to 0.57, p = 0.02). The Timed Up&Go test decreased at the end of the study compared to baseline (p = 0.02). No changes were observed in the relaxation group. We conclude that a moderate exercise programme in patients with cirrhosis improves functional capacity, increases muscle mass, and decreases body fat and the Timed Up&Go time. TRIAL REGISTRATION ClinicalTrials.gov NCT01447537.
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Affiliation(s)
- Eva Román
- Gastroenterology Department, Institut de Recerca-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Escola Universitària d’Infermeria EUI Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina García-Galcerán
- Gastroenterology Department, Institut de Recerca-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Teresa Torrades
- Physical Medicine and Rehabilitation Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Silvia Herrera
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Marín
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maite Doñate
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Edilmar Alvarado-Tapias
- Gastroenterology Department, Institut de Recerca-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Malouf
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Nácher
- Gastroenterology Department, Institut de Recerca-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ricard Serra-Grima
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carlos Guarner
- Gastroenterology Department, Institut de Recerca-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Cordoba
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, Internal Medicine Department, Hospital Vall d’Hebron, Barcelona, Spain
| | - German Soriano
- Gastroenterology Department, Institut de Recerca-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
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Moya-Nájera D, Borreani S, Moya-Herraiz Á, Calatayud J, López-Andújar R, Colado JC. ¿Es perjudicial el ejercicio físico para el trasplantado de hígado? Revisión de la literatura. Cir Esp 2016; 94:4-10. [DOI: 10.1016/j.ciresp.2015.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 01/14/2023]
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16
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Dela Cruz AC, Vilchez V, Kim S, Barnes B, Ravinuthala A, Zanni A, Galuppo R, Sourianarayanane A, Patel T, Maynard E, Shah MB, Daily MF, Uhl T, Esser K, Gedaly R. A prospective analysis of factors associated with decreased physical activity in patients with cirrhosis undergoing transplant evaluation. Clin Transplant 2015; 29:958-64. [PMID: 26263921 DOI: 10.1111/ctr.12602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Physical activity (PA) has been associated with improved recovery time after transplantation. Handgrip strength has been related to post-transplant outcomes. AIM To evaluate predictors of PA and grip strength in patients with cirrhosis undergoing liver transplant evaluation. METHODS Single-center, prospective analysis. RESULTS One hundred patients were evaluated (54% male, mean age 53 ± 9). Common etiologies of liver disease were non-alcoholic steatohepatitis (27%), hepatitis C (22%) and alcoholic liver disease (21%). Mean model of end-stage liver disease (MELD) score was 13.5. Forty-one percent had a history of smoking. Ninety-three patients completed the International Physical Activity Questionnaire (IPAQ). The median total PA score was 33 metabolic equivalent (MET)-min/wk. The mean total grip strength was 62.1 ± 22 lb. Total grip strength was found to be an independent predictor of low-moderate PA (OR 4.7, 95% CI 1.4-16.2, p = 0.038), and smoking was the only significant factor associated with reduced grip strength (OR 3.4, 95% CI 1.4-8, p = 0.005). CONCLUSIONS Patients with end-stage liver disease undergoing liver transplant evaluation have reduced total PA by IPAQ. Total grip strength was found to be a significant predictor of low-moderate PA in patients with cirrhosis. Smoking is a risk factor for reduced grip strength, an important indicator of muscle wasting in cirrhotics.
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Affiliation(s)
- Anna Christina Dela Cruz
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Valery Vilchez
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Sooyeon Kim
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Benjamin Barnes
- Center for Muscle Biology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Abhishek Ravinuthala
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Anthony Zanni
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Roberto Galuppo
- Department of Radiology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Achuthan Sourianarayanane
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Trushar Patel
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Erin Maynard
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Malay B Shah
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Michael F Daily
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Timothy Uhl
- Center for Muscle Biology, University of Kentucky, College of Medicine, Lexington, KY, USA.,Department of Rehabilitation Sciences, University of Kentucky, College of Health Sciences, Lexington, KY, USA
| | - Karyn Esser
- Center for Muscle Biology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Roberto Gedaly
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
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Krüger RL, Teixeira BC, Dias AS, Reischak-Oliveira Á. The influence that hepatic cirrhosis provides in exercise capacity and muscle strength: a review. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.003.ar02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AbstractIntroduction Hepatic cirrhosis leads to a series of physiological changes, among which stand out cardiorespiratory and muscle impairments. These changes determine a negative impact on quality of life and may cause physical inactivity.Objective The objective of this study was to review, in the most current scientific literature, the influence that hepatic cirrhosis provides in exercise capacity and muscle strength, and the effect of exercise when applied to this situation.Materials and methods For this review, research on original studies was carried out on Medical Literature Analysis and Retrieval System Online (assessed by PubMed), Scopus and Web of Science between the years 1990 to 2015. In order to be included, studies had to meet the following criteria: a) be from original articles; b) evaluate exercise capacity or muscle strength; and c) provide relevant results.Results and Discussion : The majority of studies concluded that the exercise capacity and muscle strength are decreased in individuals with cirrhosis when compared to control subjects.Final considerations Hepatic cirrhosis has negative effect on cardiorespiratory and neuromuscular capacity during physical exercise in individuals with liver disease.
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Cavallini J, Forsberg A, Lennerling A. Social function after solid organ transplantation: An integrative review. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/0107408315592335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The way organ transplant recipients depend on social interactions to develop and experience social health and well-being is similar to that of the general population. A transplant may result in a close to full recovery of health status, but the physical and social problems can persist in some patients. The focus on improving the recipients’ social participation has therefore become an important issue. The purpose of this integrative literature review was study social function after solid organ transplantation, that is, kidney, liver, lung or heart. An integrative review was performed on studies that matched the selection criteria and published in peer-reviewed journals from January 2000 to December 2014. The information from the text was extracted and patterns of social function were categorized into different subgroups that were further looked at, and five categories emerged: 1) work, 2) education, 3) daily activities and leisure, 4) social adaption and 5) barriers. The key aspects of social functioning involve five vital domains, that is, work, education, daily activities and leisure, social adaption and barriers. Returning to work appears to be the most important for the recipients independently of the transplanted organ.
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Affiliation(s)
| | - Anna Forsberg
- Department of Health Sciences, Lund University, Sweden
- Department of Transplantation and Cardiology, Skåne University Hospital, Sweden
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Sweden
- The Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Sweden
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19
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Trájer E, Bosnyák E, Komka Z, Kováts T, Protzner A, Szmodis M, Tóth S, Udvardy A, Tóth M. Retrospective Study of the Hungarian National Transplant Team's Cardiorespiratory Capacity. Transplant Proc 2015; 47:1600-4. [DOI: 10.1016/j.transproceed.2015.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/10/2015] [Indexed: 02/06/2023]
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20
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Mancuzo EV, Pereira RM, Sanches MD, Mancuzo AV. Pre-Transplant Aerobic Capacity and Prolonged Hospitalization After Liver Transplantation. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:87-92. [PMID: 28868384 PMCID: PMC5580179 DOI: 10.1016/j.jpge.2015.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/01/2015] [Indexed: 12/22/2022]
Abstract
Introduction Patients with end stage liver disease (ESLD) referred for liver transplantation (LT) are forwarded to pulmonary evaluation before being operated. ESLD is associated with muscle wasting, reduced exercise tolerance and aerobic capacity. Objectives We assessed the association between aerobic capacity (AC), liver disease severity and postoperative LT outcomes in a series of LT candidates in a university affiliated hospital in Brazil. Methods Pre-LT oxygen uptake at peak (pre-VO2peak), liver disease severity, and early pos-LT outcomes such as length of intensive care unit (ICU) stay, <5 and ≥5 days and hospitalization, <20 and ≥20 days and postoperative mortality were compared. Pre-VO2peak was measured through the cardiopulmonary exercise testing (CPET). Severity of liver disease was estimated by the Model for End-Stage Liver Disease (MELD) categorization into MELD < 18 and MELD ≥ 18 groups. Student's t-test was used to compare these groups. A logistic regression model was built to verify the effect of those variables on the length of ICU stay, length of hospitalization and postoperative mortality. Results A total of 47 patients were include in analysis. Pre-VO2peak was similar to that of healthy sedentary individuals (75 ± 18%) and worse in the MELD ≥ 18 group as compared to the MELD < 18 group (19.51 ± 7.87 vs 25.21 ± 8.76 mL/kg/min, respectively; p = 0.048). According to the multivariate analysis, only a lower pre-VO2peak (<20.09 ± 4.83 mL/kg/min) was associated to a greater length of hospitalization (p = 0.01). Conclusions In LT candidates, a reduced pre-VO2peak may predict a higher risk of greater pos-LT length of hospitalization. The length of ICU stay and postoperative mortality were not associated with variables studied. This finding should be evaluated in other studies before making specific recommendations about a routine use of CPET in LT candidates.
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Affiliation(s)
- Eliane Viana Mancuzo
- Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rossana Martins Pereira
- Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Dias Sanches
- Surgery, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra Viana Mancuzo
- Clinical Research Center, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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21
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Personalized adapted physical activity before liver transplantation: acceptability and results. Transplantation 2015; 99:145-50. [PMID: 25531893 DOI: 10.1097/tp.0000000000000245] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Altered aerobic capacity and muscular strength among patients suffering from cirrhosis are poor prognosis factors of the overall survival after liver transplantation (LT). A program of adapted physical activity (APA) is recommended in patients awaiting solid organ transplantation. However, there is no standard program in LT, and therefore none is applied. METHODS Prospective pilot study to evaluate the acceptability of a 12-week personalized APA and its impact on aerobic capacity, muscle strength, and quality of life before LT. RESULTS Thirteen patients (six men, seven women) were included. Five patients interrupted the program: two for personal convenience, two were transplanted before the end of the program, and one for deterioration of the general condition. Eight patients (mean age, 51 ± 12 years; mean Child Pugh, 7 ± 3; and mean model for end-stage liver disease score, 13 ± 6) completed the program. The mean VO2 peak values increased from 21.5 ± 5.9 mL/kg per min at baseline to 23.2 ± 5.9 mL/kg per min after 12 weeks of training (P<0.008). The maximum power (P=0.02), the 6-min walk distance (P<0.02), the strength testing of knee extensor muscles (P=0.008), and the ventilatory threshold power (P=0.02) were also significantly increased. Quality of life scale showed a global trend to improvement. No adverse event was observed. CONCLUSION A personalized and standardized APA is acceptable, effective and safe in patients awaiting LT. It positively influences the index of fitness and quality of life. Its promising impact on the posttransplantation period, duration of hospitalization, and 6-month survival needs to be prospectively evaluated in a large randomized study.
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22
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Effects of physical activity upon the liver. Eur J Appl Physiol 2014; 115:1-46. [DOI: 10.1007/s00421-014-3031-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 10/14/2014] [Indexed: 02/07/2023]
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23
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Hansen L, Yan Y, Rosenkranz SJ. The power of the liver transplant waiting list: a case presentation. Am J Crit Care 2014; 23:510-5. [PMID: 25362676 DOI: 10.4037/ajcc2014399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
End-stage liver disease (ESLD), the final stage of chronic liver disease, is treated with liver transplant. Many patients have serious ESLD-related complications and are admitted to the intensive care unit for treatment. Such patients are temporarily unsuitable to undergo transplant surgery and are placed into a temporarily inactive category, "status 7," on the transplant waiting list. Status 7 patients account for about 15% of all patients on the list. To describe the experience of a status 7 patient on the liver transplant waiting list from the perspectives of family members, 38 hours of bedside observation of participants, 9 semistructured interviews with 6 family members, and 9 semistructured interviews with 8 health care professionals from nursing, medicine, and other health care disciplines were done. Data were analyzed via conventional content analysis. Family members' perspectives fit into 3 phases that correspond to the progression of the patient's clinical condition: dealing with crisis, confusion and frustration, and back on the road to transplant. All 3 phases related to 1 goal: getting the patient's status reactivated on the liver transplant waiting list. This case exposes the struggles that patients with ESLD and their families may go through during the status 7 period and could serve as a starting point for further examination of this period.
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Affiliation(s)
- Lissi Hansen
- Lissi Hansen is an associate professor, Yi Yan is a graduate student, and Susan J. Rosenkranz is a research associate in the School of Nursing at Oregon Health & Science University in Portland
| | - Yi Yan
- Lissi Hansen is an associate professor, Yi Yan is a graduate student, and Susan J. Rosenkranz is a research associate in the School of Nursing at Oregon Health & Science University in Portland
| | - Susan J. Rosenkranz
- Lissi Hansen is an associate professor, Yi Yan is a graduate student, and Susan J. Rosenkranz is a research associate in the School of Nursing at Oregon Health & Science University in Portland
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Abstract
Liver transplantation is the only definitive treatment therapy for end-stage liver disease. In the United States, approximately 15% of annual liver transplant recipients are 65 or older. The most common postoperative complications are infection, acute graft rejection, and acute renal failure. To prevent complications, recipients are treated with immunosuppressive medications and anti-infective agents. The long-term complications of liver transplantation are a consequence of long-term use of immunosuppressive medications and recurrence of the original disease in the liver. Nurses play a critical role in supporting and educating recipients and their primary support persons about post-transplant follow-up care, including laboratory test schedules, medication management, and infection prevention. Strict compliance with follow-up care provides the greatest possibility of avoiding complications or organ rejection.
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25
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Bernal W, Martin-Mateos R, Lipcsey M, Tallis C, Woodsford K, McPhail MJ, Willars C, Auzinger G, Sizer E, Heneghan M, Cottam S, Heaton N, Wendon J. Aerobic capacity during cardiopulmonary exercise testing and survival with and without liver transplantation for patients with chronic liver disease. Liver Transpl 2014; 20:54-62. [PMID: 24136710 DOI: 10.1002/lt.23766] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
Chronic liver disease (CLD) is associated with muscle wasting, reduced exercise tolerance and aerobic capacity (AC). Measures of AC determined with cardiopulmonary exercise testing (CPET) may predict survival after liver transplantation (LT), but the relationship with nontransplant outcomes is uncertain. In patients assessed for LT, we examined the relationship of CPET AC parameters with the severity of liver disease, nutritional state, and survival with and without LT. Patients assessed for elective first LT who underwent CPET and an anthropometric assessment at a single center were studied. CPET-derived measures of AC that were evaluated included the peak oxygen consumption (VO2 peak) and the anaerobic threshold (AT). Three hundred ninety-nine patients underwent CPET, and 223 underwent LT; 45% of the patients had a VO2 peak < 50% of the predicted value, and 31% had an AT < 9 mL/kg/minute. The VO2 peak and AT values correlated with the Model for End-Stage Liver Disease score, but they more closely correlated with serum sodium and albumin levels. The handgrip strength correlated strongly with the VO2 peak. Patients with impaired AC had prolonged hospitalization after LT, and nonsurvivors had lower AT values than survivors 1 year after transplantation (P < 0.05); this was significant in a multivariate analysis. One hundred seventy-six patients did not undergo LT; the 1-year mortality rate was 34.6%. The AT (P < 0.05) and VO2 peak values (P < 0.001) were lower for nonsurvivors. In a multivariate analysis, AT was independently associated with nonsurvival. In conclusion, AC was markedly impaired in many patients with CLD. In patients who did not undergo transplantation, impaired AT was predictive of mortality, and in patients undergoing LT, it was related to postoperative hospitalization and survival. AC should be evaluated as a modifiable factor for improving patient survival whether or not LT is anticipated.
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Affiliation(s)
- William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, King's College London, London, United Kingdom
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Duvivier A. Enjeux et intérêts de l’épreuve d’effort cardiorespiratoire en transplantation hépatique. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-013-0830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Organ transplantation is one of the medical miracles or the 20th century. It has the capacity to substantially improve exercise performance and quality of life in patients who are severely limited with chronic organ failure. We focus on the most commonly performed solid-organ transplants and describe peak exercise performance following recovery from transplantation. Across all of the common transplants, evaluated significant reduction in VO2peak is seen (typically renal and liver 65%-80% with heart and/or lung 50%-60% of predicted). Those with the lowest VO2peak pretransplant have the lowest VO2peak posttransplant. Overall very few patients have a VO2peak in the normal range. Investigation of the cause of the reduction of VO2peak has identified many factors pre- and posttransplant that may contribute. These include organ-specific factors in the otherwise well-functioning allograft (e.g., chronotropic incompetence in heart transplantation) as well as allograft dysfunction itself (e.g., chronic lung allograft dysfunction). However, looking across all transplants, a pattern emerges. A low muscle mass with qualitative change in large exercising skeletal muscle groups is seen pretransplant. Many factor posttransplant aggravate these changes or prevent them recovering, especially calcineurin antagonist drugs which are key immunosuppressing agents. This results in the reduction of VO2peak despite restoration of near normal function of the initially failing organ system. As such organ transplantation has provided an experiment of nature that has focused our attention on an important confounder of chronic organ failure-skeletal muscle dysfunction.
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Affiliation(s)
- Trevor J Williams
- Department of Allergy, Immunology, and Respiratory Medicine Alfred Hospital and Monash University, Melbourne, Australia.
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28
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The Impact of Exercise Training on Liver Transplanted Familial Amyloidotic Polyneuropathy (FAP) Patients. Transplantation 2013; 95:372-7. [DOI: 10.1097/tp.0b013e31827220e7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Kallwitz ER. Metabolic syndrome after liver transplantation: Preventable illness or common consequence? World J Gastroenterol 2012; 18:3627-34. [PMID: 22851856 PMCID: PMC3406416 DOI: 10.3748/wjg.v18.i28.3627] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/25/2012] [Accepted: 06/28/2012] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome is common after liver transplant being present in approximately half of recipients. It has been associated with adverse outcomes such as progression of hepatitis C and major vascular events. As the United States population ages and the rate of obesity increases, prevention of the metabolic syndrome in the post-transplant population deserves special consideration. Currently, the metabolic syndrome after transplant appears at least two times more common than observed rates in the general population. Specific guidelines for patients after transplant does not exist, therefore prevention rests upon knowledge of risk factors and the presence of modifiable elements. The current article will focus on risk factors for the development of the metabolic syndrome after transplant, will highlight potentially modifiable factors and propose potential areas for intervention. As in the non-transplant population, behavioral choices might have a major role. Opportunities exist in this regard for health prevention studies incorporating lifestyle changes. Other factors such as the need for immunosuppression, and the changing characteristics of wait listed patients are not modifiable, but are important to know in order to identify persons at higher risk. Although immunosuppression after transplant is unavoidable, the contribution of different agents to the development of components of the metabolic syndrome is also discussed. Ultimately, an increased risk of the metabolic syndrome after transplant is likely unavoidable, however, there are many opportunities to reduce the prevalence.
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30
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Jones JC, Coombes JS, Macdonald GA. Exercise capacity and muscle strength in patients with cirrhosis. Liver Transpl 2012; 18:146-51. [PMID: 22139897 DOI: 10.1002/lt.22472] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Exercise capacity and muscle strength are predictors of outcome in a number of clinical populations. Advanced liver disease is a catabolic state, and patients often have muscle wasting. However, the relationships between exercise capacity, strength, and outcomes for patients undergoing liver transplantation are poorly understood. Thirteen studies have examined the association between these parameters in patients with cirrhosis, and they have found a significant reduction in the exercise capacity and muscle strength of patients with cirrhosis versus healthy controls. These impairments appear to be independent of the etiology of cirrhosis, but the data are equivocal with respect to their association with disease severity. Two studies reported a significant and independent association between pretransplant exercise capacity and posttransplant survival. Another 2 studies found that exercise training was well tolerated in patients with cirrhosis and resulted in improvements in exercise capacity (both studies) and muscle mass (1 study). These data are provocative and suggest that measuring and improving the exercise capacity and muscle strength of patients with cirrhosis who are awaiting liver transplantation could potentially improve outcomes.
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Affiliation(s)
- Jacqueline C Jones
- School of Human Movement Studies, Hepatology and Liver Research Centre, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
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31
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Tomás MT, Santa-Clara MH, Monteiro E, Baynard T, Carnero EÁ, Bruno PM, Barroso E, Sardinha LB, Fernhall B. Body composition, muscle strength, functional capacity, and physical disability risk in liver transplanted familial amyloidotic polyneuropathy patients. Clin Transplant 2011; 25:E406-14. [PMID: 21418328 DOI: 10.1111/j.1399-0012.2011.01436.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Familial amyloidotic polyneuropathy (FAP) is a neurodegenerative disease leading to sensory and motor polyneuropathies, and functional limitations. Liver transplantation is the only treatment for FAP, requiring medication that negatively affects bone and muscle metabolism. The aim of this study was to compare body composition, levels of specific strength, level of physical disability risk, and functional capacity of transplanted FAP patients (FAPTx) with a group of healthy individuals (CON). METHODS A group of patients with 48 FAPTx (28 men, 20 women) was compared with 24 CON individuals (14 men, 10 women). Body composition was assessed by dual-energy X-ray absorptiometry, and total skeletal muscle mass (TBSMM) and skeletal muscle index (SMI) were calculated. Handgrip strength was measured for both hands as was isometric strength of quadriceps. Muscle quality (MQ) was ascertained by the ratio of strength to muscle mass. Functional capacity was assessed by the six-minute walk test. RESULTS Patients with FAPTx had significantly lower functional capacity, weight, body mass index, total fat mass, TBSMM, SMI, lean mass, muscle strength, MQ, and bone mineral density. CONCLUSION Patients with FAPTx appear to be at particularly high risk of functional disability, suggesting an important role for an early and appropriately designed rehabilitation program.
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Affiliation(s)
- Maria T Tomás
- Exercise and Health Laboratory, Faculty of Human Kinetics, Technical University of Lisbon, Portugal.
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Senduran M, Yurdalan SU, Karadibak D, Gunerli A. Haemodynamic effects of physiotherapy programme in intensive care unit after liver transplantation. Disabil Rehabil 2010; 32:1461-6. [PMID: 20533874 DOI: 10.3109/09638280903531212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the haemodynamic effects of intensive care physiotherapy after liver transplantation. PATIENTS AND METHODS Thirteen patients were included in the study after liver transplantation. The following physiotherapy programme were applied to the patients in intensive care unit: Respiratory physiotherapy, active joint movements, sitting in bed (first task), sitting at the edge of bed (second task), standing (third task), sitting out of bed (fourth task) and walking (fifth task). Heart rate (HR), mean, systolic and diastolic blood pressures (MBP, SBP, DBP), peripheral oxygen saturation (SpO(2)), respiration rate (RR) were recorded before treatment, after each task, after treatment and at the fifth minute of recovery. Pain level was assessed with Visual Analogue Scale (0-10). RESULTS When compared with supine position before treatment, all of the parameters except RR increased after the first task whereas HR, SBP, MBP and pain increased after the second task. After the third task only HR and pain increased. There was no significant difference between the fourth task and pre-treatment values while HR, DBP and pain increased after the fifth task. When measurements of pre-treatment, immediately after treatment and the fifth minute of recovery were compared HR, MBP and pain increased after treatment whereas HR, RR and pain decreased after recovery. There was no significant difference between pre-treatment values and fifth minute of recovery measurements. CONCLUSION Returning to initial values after a 5-min period shows that cardiopulmonary changes caused by intensive care physiotherapy after liver transplantation are responded at physiological limits.
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Affiliation(s)
- Meric Senduran
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.
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Fink EL, Beers SR, Russell ML, Bell MJ. Acute brain injury and therapeutic hypothermia in the PICU: A rehabilitation perspective. J Pediatr Rehabil Med 2009; 2:309-19. [PMID: 21791822 PMCID: PMC3235956 DOI: 10.3233/prm-2009-0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Acquired brain injury from traumatic brain injury, cardiac arrest (CA), stroke, and central nervous system infection is a leading cause of morbidity and mortality in the pediatric population and reason for admission to inpatient rehabilitation. Therapeutic hypothermia is the only intervention shown to have efficacy from bench to bedside in improving neurological outcome after birth asphyxia and adult arrhythmia-induced CA, thought to be due to its multiple mechanisms of action. Research to determine if therapeutic hypothermia should be applied to other causes of brain injury and how to best apply it is underway in children and adults. Changes in clinical practice in the hospitalized brain-injured child may have effects on rehabilitation referral practices, goals and strategies of therapies offered, and may increase the degree of complex medical problems seen in children referred to inpatient rehabilitation.
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Affiliation(s)
- Ericka L. Fink
- Department of Critical Care Medicine, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Faculty Pavilion, 2nd floor, Pittsburgh, PA, USA
| | - Sue R. Beers
- Department of Psychiatry, University of Pittsburgh, Oxford Building, Rm. 724, Pittsburgh, PA, USA
| | - Mary Louise Russell
- Department of Children’s Rehabilitation Services, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 2nd floor, Pittsburgh, PA, USA
| | - Michael J. Bell
- Department of Critical Care Medicine, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Faculty Pavilion, 2nd floor, Pittsburgh, PA, USA
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Quality of life after liver transplantation. A systematic review. J Hepatol 2008; 48:567-77. [PMID: 18279999 DOI: 10.1016/j.jhep.2007.12.013] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 12/19/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS Although many studies have reported significant improvements in quality of life (QOL) after liver transplantation (LT), consistent data on areas of improvement are lacking. To perform a systematic review on medical literature of QOL after LT paying particular attention to studies that utilized the most commonly adopted study instrument, Short Form-36 (SF-36). METHODS To collect studies focused on QOL in adult LT recipients, from 1963 to 2007, cited in Pub Med, Embase or Cochrane databases. From an initial identification of 613 articles, we selected 44 longitudinal studies with pre- and post-LT data that we assessed using a sign test, and 19 used SF-36, which we analyzed separately. RESULTS Longitudinal data showed remarkable improvement of common domains of QOL comparing pre- and post-transplant items. However, analysis of 16 SF-36 cross-sectional studies comparing post-LT patient domains with control population showed significantly higher ratings for controls in six while no differences were found in two. CONCLUSIONS This review suggests that whereas general QOL improves after LT, when compared with healthy controls, LT recipients have significant deficits in QOL. Consequently, the previously reported QOL benefits after LT may have been overstated.
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