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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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Spillman LN, Madden AM, Richardson H, Imamura F, Jones D, Nash M, Lim HK, Hellawell HN, Rennie KL, Oude Griep LM, Allison M, Griffin SJ. Nutritional Intake after Liver Transplant: Systematic Review and Meta-Analysis. Nutrients 2023; 15:2487. [PMID: 37299450 PMCID: PMC10255417 DOI: 10.3390/nu15112487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Cardiovascular disease and its concurrent risk factors are prevalent after liver transplant (LT). Most of these risk factors are modifiable by diet. We aimed to synthesise the literature reporting the nutritional intake of liver transplant recipients (LTR) and the potential determinants of intake. We performed a systematic review and meta-analyses of studies published up until July 2021 reporting the nutritional intake of LTR. The pooled daily mean intakes were recorded as 1998 (95% CI 1889, 2108) kcal, 17 (17, 18)% energy from protein, 49 (48, 51)% energy from carbohydrates, 34 (33, 35)% energy from total fat, 10 (7, 13)% energy from saturated fat, and 20 (18, 21) g of fibre. The average fruit and vegetable intake ranged from 105 to 418 g/day. The length of time post-LT and the age and sex of the cohorts, as well as the continent and year of publication of each study, were sources of heterogeneity. Nine studies investigated the potential determinants of intake, time post-LT, gender and immunosuppression medication, with inconclusive results. Energy and protein requirements were not met in the first month post-transplant. After this point, energy intake was significantly higher and remained stable over time, with a high fat intake and low intake of fibre, fruits and vegetables. This suggests that LTR consume a high-energy, low-quality diet in the long term and do not adhere to the dietary guidelines for cardiovascular disease prevention.
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Affiliation(s)
- Lynsey N. Spillman
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
- Liver Transplant Unit, Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Angela M. Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (A.M.M.); (H.R.)
| | - Holly Richardson
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (A.M.M.); (H.R.)
| | - Fumiaki Imamura
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
| | - Danielle Jones
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
| | - Marilyn Nash
- Department of Nutrition and Dietetics, East Suffolk and North Essex NHS Foundation Trust, Colchester CO4 5JL, UK
| | - Hong Kai Lim
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK; (H.K.L.); (H.N.H.)
| | - Holly N. Hellawell
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK; (H.K.L.); (H.N.H.)
| | - Kirsten L. Rennie
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
| | - Linda M. Oude Griep
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
| | - Michael Allison
- Liver Transplant Unit, Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Simon J. Griffin
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (F.I.); (D.J.); (K.L.R.); (L.M.O.G.); (S.J.G.)
- Department of Public Health and Primary Care, Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SR, UK
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Does Exercise Training Improve Physical Fitness and Health in Adult Liver Transplant Recipients? A Systematic Review and Meta-analysis. Transplantation 2023; 107:e11-e26. [PMID: 36192838 DOI: 10.1097/tp.0000000000004313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The impaired physical fitness of end-stage liver disease patients often persists after liver transplantation (LT) and compromises posttransplant recovery. This systematic review and meta-analysis evaluated evidence supporting the potential of exercise training to improve physical fitness and health-related quality of life (HRQOL) after LT. METHODS Bibliographic searches identified all randomized controlled trials (RCTs) comparing aerobic and strength training versus usual care after LT. Risk of bias was assessed, and study outcomes measuring physical fitness and HRQOL were extracted. Meta-analysis was performed if at least 3 studies reported on an outcome. RESULTS Eight RCTs (n = 334) were identified. Methodological study quality varied and was poorly reported. Meta-analyses showed a trend for favorable effects of exercise on cardiorespiratory fitness (peak oxygen uptake or 6-min walking distance; 6 studies, n = 275; standardized mean difference: 0.23, 95% confidence interval [CI], -0.01 to 0.48) and of strength training either or not combined with aerobic training on muscular fitness (dynamometry-assessed muscle strength or 30-s sit-to-stand test; 3 studies, n = 114; standardized mean difference: 0.34, 95% CI, -0.03 to 0.72). A favorable effect was found for exercise on the Short-Form Health Survey-36 HRQOL physical function subcomponent (3 studies, n = 194; mean difference: 9.1, 95% CI, 0.3-17.8). No exercise-related adverse events were observed. CONCLUSIONS RCTs indicate that exercise training in LT recipients is safe, improves physical function aspects of HRQOL, and may benefit cardiorespiratory and muscular fitness. The strength of evidence is, however, limited by the low number of patients and study quality. More adequately powered, high-quality RCTs are warranted.
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Ahmed O, Lee A, Vachharajani N, Chang SH, Park Y, Khan AS, Chapman WC, Doyle MM. Reviewing Patient-Reported Outcomes 1 Year after Orthotopic Liver Transplantation. J Am Coll Surg 2022; 235:69-77. [PMID: 35703964 DOI: 10.1097/xcs.0000000000000244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND With improved survivorship in liver transplantation (LT), there is an emerging focus on functional recovery and health-related quality of life (HRQoL) after surgery. The present study aimed to assess HRQoL after LT using the Patient-Reported Outcomes Measurement Information System (PROMIS). STUDY DESIGN This was a prospective analysis of LT recipients between 2020 and 2021. A total of 238 patients were contacted by phone at 3, 6, and 12 months postoperatively using the PROMIS 29-Profile. Scores were recorded and computed using the HealthMeasures Scoring Service. RESULTS PROMIS was available for 174 patients at 3 (n = 58), 6 (n = 57), and 12 months (n = 59). Overall, mean PROMIS scores were 47.6 ± 3, 47.6 ± 3, and 47.6 ± 3 at 3, 6, and 12 months, respectively. Most domains improved postoperatively by 12 months except for anxiety and sleep disturbance measures. The lowest domain in the immediate postoperative period was physical functioning, but this had the closest return to normative population values. Pain interference was above the population reference during the initial postoperative period, improving by 12 months where they were below mean population values. Depression and fatigue scores improved by 6 months and appeared to stabilize by 12 months post-LT. Patients demonstrated increased social participation, and scores were remarkably higher than general population means at each timepoint. CONCLUSION LT can impact physical, mental, and social health which, in this setting, remains largely unexplored using PROMIS instruments. We report that although overall patient well being can improve, some mental health domains require further consideration during the postoperative period.
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Affiliation(s)
- Ola Ahmed
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - Angela Lee
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - Neeta Vachharajani
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery (Chang, Park), Washington University School of Medicine, St. Louis, MO
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery (Chang, Park), Washington University School of Medicine, St. Louis, MO
| | - Adeel S Khan
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - William C Chapman
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
| | - Mb Majella Doyle
- From the Division of Abdominal Organ Transplantation, Department of Surgery (Ahmed, Lee, Vachharajani, Khan, Chapman, Doyle)
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5
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Nguyen M, Mukaneza Y, Tremblay M, Huard G, Tang A, Rose CF, Bémeur C. Renal dysfunction independently predicts muscle mass loss in patients following liver transplantation. CANADIAN LIVER JOURNAL 2022; 5:411-423. [DOI: 10.3138/canlivj-2021-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Liver transplantation (LT) is the only curative treatment for cirrhosis. However, the presence of complications can impact outcomes following LT. Sarcopenia, or muscle mass loss, is highly prevalent in patients with cirrhosis and is associated with longer hospitalization stays and a higher infection rate post-surgery. We aimed to identify patients at higher risk of early sarcopenia post-LT. METHODS: This retrospective study included 79 cirrhotic patients who underwent LT. Muscle mass was evaluated using the third lumbar spine vertebra skeletal muscle mass index (SMI) and sarcopenia was defined using established cut-off values. Computerized tomography (CT) scans performed within six-month peri-operative period (three months pre- and post-LT) were included in the study. Complications and comorbidities were collected and correlated to SMI post-LT and predictive models for SMI post-LT were constructed. RESULTS: The overall prevalence of sarcopenia was 46% and 62% before and after LT, respectively. Newly developed sarcopenia was found in 42% of patients. Post-LT sarcopenia was associated with longer hospital stays (54±37 vs 29±10 days, p = 0.002), higher number of infection (3±1 vs 1±2, p = 0.027), and greater number of complications (5±2 vs 3±2, p <0.001) compared to absence of sarcopenia. Multivariate analyses showed that the SMI post-LT was independently associated with pre-LT renal function markers, the glomerular filtration rate (GFR) and creatinine (Model 1, GFR: β = 0.33; 95% CI = 0.04–0.17; p = 0.003; Model 2, Creatinine: β = –0.29; 95% CI = –0.10 to –0.02; p = 0.009). CONCLUSIONS: The present study highlights the potential role of renal dysfunction in the development and persistence of sarcopenia after LT.
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Affiliation(s)
- Mimosa Nguyen
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Yvette Mukaneza
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Mélanie Tremblay
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Geneviève Huard
- Centre hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - An Tang
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Centre hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Christopher F Rose
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Chantal Bémeur
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Department of Nutrition, Université de Montréal, Montréal, Québec, Canada
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6
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Cristin DJ, Forman LM, Jackson WE. Beyond Survival: Targeting Health-Related Quality of Life Outcomes After Liver Transplantation. Clin Liver Dis (Hoboken) 2021; 17:359-364. [PMID: 34136142 PMCID: PMC8177828 DOI: 10.1002/cld.1059] [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: 06/30/2020] [Revised: 10/14/2020] [Accepted: 10/25/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- David J. Cristin
- Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterAuroraCO
| | - Lisa M. Forman
- Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterAuroraCO
| | - Whitney E. Jackson
- Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterAuroraCO
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Cappelle M, Masschelein E, Vos R, Van Remoortel H, Smets S, Vanbekbergen J, Verreydt J, Troosters T, Goetschalckx K, Gosselink R, Monbaliu D. High-Intensity Training for 6 Months Safely, but Only Temporarily, Improves Exercise Capacity in Selected Solid Organ Transplant Recipients. Transplant Proc 2021; 53:1836-1845. [PMID: 34049699 DOI: 10.1016/j.transproceed.2021.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Organ transplantation is a life-saving intervention that improves quality of life of patients with irreversible organ failure. Although exercise training immediately after transplantation has been suggested to be beneficial, such interventions remain rare in stable transplant recipients, whereas effects of high-intensity training (HIT) are even less frequently investigated. Moreover, sustainability of such interventions has not yet been reported. We investigated the effects of a 6-month, cycling-based HIT program on physical performance in long-term stable solid organ transplant (SOT) recipients, with follow-up evaluation after 6 months. METHODS Forty-two adult, stable, and selected SOT recipients participated in a 6-month individualized home- and group-based HIT program. Exercise capacity (VO2max), maximal power (Wmax), and body mass index were measured before, at the end, and 6 months after completion of the intervention. RESULTS The study comprised 12 heart, 7 lung, 8 liver, and 15 kidney recipients (mean age, 41.4 ± 11.1 years; median time posttransplant, 3.4 [1.7-8.0] years). For 6 months, VO2max increased in the heart, lung, and kidney groups, Wmax increased in the heart group, and body mass index decreased in the liver group. Six months after the HIT program, the achieved gain in exercise capacity had disappeared in all groups. CONCLUSION Despite voluntary participation selection bias, our observations indicate that HIT is safe and may result in a beneficial effect on physical performance in selected, stable SOT recipients. However, there was no sustained beneficial effect once training stopped. Larger scale and longer term studies are still required to investigate longevity of improvement and overall beneficial effects on clinical outcomes.
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Affiliation(s)
- Marie Cappelle
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Evi Masschelein
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Department CHROMETA, BREATHE, KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Hans Van Remoortel
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Sven Smets
- Department of Nephrology, Sint Trudo Hospital, Sint-Truiden, Belgium
| | - Jonas Vanbekbergen
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Joris Verreydt
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.
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8
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Spillman LN, Melville-Claxton A, Gatiss GA, Fernandez N, Madden AM. Diet and physical activity after liver transplant: A qualitative study of barriers and facilitators to following advice. J Hum Nutr Diet 2021; 34:910-919. [PMID: 33646641 DOI: 10.1111/jhn.12874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/10/2021] [Accepted: 02/04/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Liver transplant recipients are given diet and physical activity advice to aid recovery and promote long-term health. The present study aimed to explore patients' experiences of receiving and implementing diet and physical activity advice after liver transplant and identify barriers and facilitators to following recommendations. METHODS A qualitative descriptive design included purposive sampling of 13 liver transplant recipients. Semi-structured audio-recorded interviews and inductive thematic analysis using a framework were undertaken concurrently to enable recruitment until saturation of themes occurred. RESULTS Overall experiences varied between participants and settings, as well as over time. Seven themes emerged, all representing both barriers and facilitators to implementing advice. Poor capability and loss of confidence were barriers that improved in hospital because healthcare professionals enabled participants to set and achieve goals but remained key barriers after discharge from hospital. The format and consistency of advice influenced participants' confidence in the healthcare team. Social support helped participants to return to and implement advice, although social networks could also have a negative influence. Advice and modelling of behaviour from other transplant recipients were facilitators. Symptoms, side effects, comorbidities and the environment presented barriers and facilitators. The desire to return to normal and coping strategies were drivers of behaviours, which were also influenced by participants' beliefs and values. CONCLUSIONS The variation in experiences indicates a need for individually tailored advice that is consistent across the multidisciplinary team. Interventions for behaviour change that merit further investigation include goal setting, improving coping strategies, peer support and modifying the hospital and home environment.
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Affiliation(s)
- Lynsey N Spillman
- Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Arabella Melville-Claxton
- Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gillian A Gatiss
- Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nicola Fernandez
- Department of Nutrition and Dietetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Angela M Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Comparative study of the effect of neuromuscular electrical stimulation and oral administration of branched-chain amino acid on preventing sarcopenia in patients after living-donor liver transplantation: study protocol for an open-label randomized controlled trial. Trials 2021; 22:137. [PMID: 33579345 PMCID: PMC7881684 DOI: 10.1186/s13063-021-05086-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 01/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Liver cirrhosis is the irreversible fibrosis of the liver and causes refractory ascites and hepatic encephalopathy, which might not respond to treatment. Living donor liver transplantation (LDLT) is an effective treatment for patients with cirrhosis. However, post-LDLT patients are prone to muscle atrophy and sarcopenia. Therefore, physiotherapy of post-LDLT patients is essential for preventing the progression of sarcopenia. Recently, rehabilitation using neuromuscular electrical stimulation (NMES) has been reported to be useful for preventing the progression of sarcopenia. Similarly, nutrition therapy is essential for post-LDLT patients because these patients frequently experience malnutrition. However, the effects of combined NMES and nutrition therapy on post-LDLT patients remain unknown. Methods/design This open-label, randomized, parallel-group study will compare the effects of combined therapy with NMES and branched-chain amino acids (BCAA) with those of NMES alone in patients with decompensated cirrhosis after LDLT. After LDLT, 50 patients with decompensated cirrhosis will be randomly assigned to receive NMES with BCAA or NMES without BCAA. The duration of the intervention will be 3 months. To analyze the change in skeletal muscle mass, InBody 770 body composition and body water analysis and ultrasonography will be performed before LDLT and 4 weeks and 12 weeks post-LDLT. The primary endpoint is changes in the skeletal muscle mass from baseline to 3 months. Important secondary endpoints are the changes in the skeletal muscle mass from baseline to 1 month and changes in the quadriceps strength from baseline to 1 month. Discussion The results of this study are expected to provide evidence regarding the effect of NMES combined with BCAA therapy on the skeletal muscle of post-LDLT patients. Trial registration Japan Registry of Clinical Research jRCTs071190051. Registered on February 26, 2020.
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10
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Nam NH, Kaido T, Uemoto S. Assessment and significance of sarcopenia in liver transplantation. Clin Transplant 2019; 33. [PMID: 31651060 DOI: 10.1111/ctr.13741] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/21/2019] [Accepted: 10/20/2019] [Indexed: 12/12/2022]
Abstract
Sarcopenia frequently occurs in cirrhotic patients who are waiting for liver transplantation (LT). This disease is associated with increased morbidity and mortality rates during the LT period. Recently, the careful assessment of nutritional status for end-stage liver disease patients has received a great deal of attention; hence, numerous methods of evaluating sarcopenia have been proposed. However, most of the methods have limitations, including a lack of objectivity, reproducibility, and ability to discriminate prognoses. In addition, many reports suggest that sarcopenia be used as an adjustment factor for the selection criteria of LT and that sarcopenia be incorporated into the selection criteria for living donor LT in our center. In this article, based on a literature review, we aim to identify the current definition of sarcopenia, the available methods of measurement, the potential novel interventions for the treatment of malnutrition and the significance of sarcopenia in LT.
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Affiliation(s)
- Nguyen Hai Nam
- Division of Surgery, Department of Hepato Biliary Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Division of Surgery, Department of Hepato Biliary Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Surgery, Department of Hepato Biliary Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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11
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Correlates and Outcomes of Low Physical Activity Posttransplant: A Systematic Review and Meta-Analysis. Transplantation 2019; 103:679-688. [DOI: 10.1097/tp.0000000000002543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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Pravisani R, Soyama A, Isola M, Sadykov N, Takatsuki M, Hidaka M, Adachi T, Ono S, Hara T, Hamada T, Baccarani U, Risaliti A, Eguchi S. Chronological changes in skeletal muscle mass following living‐donor liver transplantation: An analysis of the predictive factors for long‐term post‐transplant low muscularity. Clin Transplant 2019; 33:e13495. [DOI: 10.1111/ctr.13495] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Riccardo Pravisani
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
- General Surgery and Transplantation Unit, Department of Medicine University of Udine Udine Italy
| | - Akihiko Soyama
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Miriam Isola
- Division of Medical Statistic, Department of Medicine University of Udine Udine Italy
| | - Nariman Sadykov
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Masaaki Hidaka
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tomohiko Adachi
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Shinichiro Ono
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Takanobu Hara
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Takashi Hamada
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Umberto Baccarani
- General Surgery and Transplantation Unit, Department of Medicine University of Udine Udine Italy
| | - Andrea Risaliti
- General Surgery and Transplantation Unit, Department of Medicine University of Udine Udine Italy
| | - Susumu Eguchi
- Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
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Mejía G, Gómez MT, Moreno-Medina K. Evaluación de la calidad de vida relacionada con la salud pre y post trasplante hepático, en pacientes de un hospital de alta complejidad. PSYCHOLOGIA 2019. [DOI: 10.21500/19002386.3721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
El trasplante hepático es la alternativa terapéutica indicada en pacientes con enfermedad hepática terminal para mejorar su sobrevida y calidad de vida. El objetivo de este estudio fue evaluar la calidad de vida relacionada con la salud (CVRS) de pacientes con cirrosis hepática antes y después de trasplante hepático. Se incluyeron 33 personas adultas que estaban en lista de espera para trasplante en la institución, se aplicó una serie de cuestionarios antes y después del trasplante: para evaluar la calidad de vida se utilizaron el LDQOL-1 (específico para enfermedad y trasplante hepático) y SF36 (para población general); para evaluar los síntomas depresivos y ansiosos, se utilizaron el BDI y STAI, respectivamente. Los resultados señalan una mejoría en la CVRS, así como disminución de los síntomas ansiosos y depresivos posterior al trasplante.
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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: 327] [Impact Index Per Article: 65.4] [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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EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70:172-193. [PMID: 30144956 PMCID: PMC6657019 DOI: 10.1016/j.jhep.2018.06.024] [Citation(s) in RCA: 534] [Impact Index Per Article: 106.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022]
Abstract
A frequent complication in liver cirrhosis is malnutrition, which is associated with the progression of liver failure, and with a higher rate of complications including infections, hepatic encephalopathy and ascites. In recent years, the rising prevalence of obesity has led to an increase in the number of cirrhosis cases related to non-alcoholic steatohepatitis. Malnutrition, obesity and sarcopenic obesity may worsen the prognosis of patients with liver cirrhosis and lower their survival. Nutritional monitoring and intervention is therefore crucial in chronic liver disease. These Clinical Practice Guidelines review the present knowledge in the field of nutrition in chronic liver disease and promote further research on this topic. Screening, assessment and principles of nutritional management are examined, with recommendations provided in specific settings such as hepatic encephalopathy, cirrhotic patients with bone disease, patients undergoing liver surgery or transplantation and critically ill cirrhotic patients.
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Chae M, Kim Y, Kim J, Ko Y, Jung J, Choi H, Chung H, Hong S, Park C, Choi J, Huh J. Perioperative Changes in the Psoas Muscle Index in Patients Undergoing ABO-Incompatible Living-Donor Liver Transplantation: A Single-Center Experience. Transplant Proc 2018; 50:3656-3660. [DOI: 10.1016/j.transproceed.2018.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/16/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023]
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Dąbrowska-Bender M, Kozaczuk A, Pączek L, Milkiewicz P, Słoniewski R, Staniszewska A. Patient Quality of Life After Liver Transplantation in Terms of Emotional Problems and the Impact of Sociodemographic Factors. Transplant Proc 2018; 50:2031-2038. [PMID: 30177104 DOI: 10.1016/j.transproceed.2018.03.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Liver transplantation is recognized as an effective and necessary treatment of chronic as well as acute hepatic failure. The assessment of quality of life (QoL) after transplantation represents an ancillary tool to evaluate the efficacy of solid organ transplantation in addition to graft and patient survival rates and complications. The global assessment of QoL after transplantation usually confirms improvement compared to pretransplant conditions. PURPOSE An attempt to evaluate the quality of life of patients after liver transplantation, with particular reference to sociodemographic factors and emotional problems. MATERIALS AND METHODS The study group included 121 patients (55 women and 66 men) at the age of 19 to 71 years who underwent surgery in the Central Teaching Hospital of the Medical University of Warsaw and the Infant Jesus Teaching Hospital in Warsaw, and were subsequently treated in an outpatient transplant clinic. The scoring procedure for the areas analyzed was based on the 36-Item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS Higher patients age was correlated with lower quality of life of patients after liver transplantation, including physical functioning (patients >40 years of age declared lower physical performance, and patients <30 years of age indicated greatest limitations in their kind of work or other activities). The frequency of pain was also age-dependent (mostly patients >50 years of age). Women more often than men had worrying thoughts, were feeling tense or wound up, and had sudden feelings of anxiety or panic. By contrast, older people often declared that they felt to be slowed down. CONCLUSIONS To reduce pain and to improve physical performance of the study patients, rehabilitation procedures should be considered. Patients indicating symptoms associated with anxiety and depression should be referred to a clinical psychologist.
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Affiliation(s)
- M Dąbrowska-Bender
- Department of Clinical Dietetics, Medical University of Warsaw, Warsaw, Poland.
| | - A Kozaczuk
- Medical University of Warsaw, Warsaw, Poland
| | - L Pączek
- Department of Immunology, Transplant Medicine and Internal Diseases, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - P Milkiewicz
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - R Słoniewski
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
| | - A Staniszewska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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Hermann HC, Grimm A, Klapp BF, Neuhaus R, Papachristou C. Body Experience After Liver Transplantation: A Body Grid Examination. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2016. [DOI: 10.1080/10720537.2016.1227736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H. C. Hermann
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - A. Grimm
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - B. F. Klapp
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - R. Neuhaus
- Department of General, Visceral, and Transplantation Surgery, Charité University Medicine Berlin, Germany
| | - C. Papachristou
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
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Evolution and Determinants of Health-Related Quality-of-Life in Kidney Transplant Patients Over the First 3 Years After Transplantation. Transplantation 2016; 100:640-7. [PMID: 26569063 DOI: 10.1097/tp.0000000000000846] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) usually improved after kidney transplantation; however, a non-negligible number of patients did not benefit from transplantation in HRQOL. The aims of this cohort study were to describe the evolution of HRQOL in kidney transplant recipients to search for subgroups with distinct time profiles and to investigate these determinants. METHODS Three hundred thirty-seven adult patients were followed up from 1 to 36 months after kidney transplantation. Each patient completed repeated HRQOL assessments (median, 5; range, 2-9). K-means for longitudinal data was used to identify homogeneous clusters of HRQOL time profiles obtained for the mental and physical composite scores (MCS and PCS) and for the 8 dimensions of the short-form 36 scale. Covariates associated with these clusters were investigated using random forest analysis. Magnitude and shape of the HRQOL variations over time were investigated using linear regression mixed models. RESULTS Two longitudinal clusters were identified for the time profiles of PCS and MCS. Patients classified in the higher cluster (ie, 60% of the population) exhibited a steady-state HRQOL, similar on average to the general population, whereas in the lower cluster, PCS and MCS scores were significantly lower than in the general population. Muscular weakness in the first year after transplantation explained 19% of the interpatient variability of PCS 3 months after transplantation, whereas associated with anxiety, it explained 24% of interpatient MCS variability. CONCLUSIONS This work suggests to promote (i) physical rehabilitation programs after transplantation to curb the muscular loss and (ii) systematic attention to the patient's anxiety.
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Dąbrowska-Bender M, Michałowicz B, Pączek L. Assessment of the Quality of Life in Patients After Liver Transplantation as an Important Part of Treatment Results. Transplant Proc 2016; 48:1697-702. [DOI: 10.1016/j.transproceed.2015.12.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/26/2015] [Accepted: 12/30/2015] [Indexed: 10/21/2022]
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Kotarska K, Wunsch E, Jodko L, Raszeja-Wyszomirska J, Bania I, Lawniczak M, Bogdanos D, Kornacewicz-Jach Z, Milkiewicz P. Factors Affecting Exercise Test Performance in Patients After Liver Transplantation. HEPATITIS MONTHLY 2016; 16:e34356. [PMID: 27226801 PMCID: PMC4875566 DOI: 10.5812/hepatmon.34356] [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: 12/01/2015] [Revised: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiovascular diseases are a leading cause of morbidity and mortality in solid organ transplant recipients. In addition, low physical activity is a risk factor for cardiac and cerebrovascular complications. OBJECTIVES This study examined potential relationships between physical activity, health-related quality of life (HRQoL), risk factors for cardiovascular disease, and an exercise test in liver-graft recipients. PATIENTS AND METHODS A total of 107 participants (62 men/45 women) who had received a liver transplantation (LT) at least 6 months previously were evaluated. Physical activity was assessed using three different questionnaires, while HRQoL was assessed using the medical outcomes study short form (SF)-36 questionnaire, and health behaviors were evaluated using the health behavior inventory (HBI). The exercise test was performed in a standard manner. RESULTS Seven participants (6.5%) had a positive exercise test, and these individuals were older than those who had a negative exercise test (P = 0.04). A significant association between a negative exercise test and a higher level of physical activity was shown by the Seven-day physical activity recall questionnaire. In addition, HRQoL was improved in various domains of the SF-36 in participants who had a negative exercise test. No correlations between physical activity, the exercise test and healthy behaviors, as assessed via the HBI were observed. CONCLUSIONS Exercise test performance was affected by lower quality of life and lower physical activity after LT. With the exception of hypertension, well known factors that affect the risk of coronary artery disease had no effect on the exercise test results.
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Affiliation(s)
- Katarzyna Kotarska
- Department of Physical Culture and Health Promotion, University of Szczecin, Szczecin, Poland
| | - Ewa Wunsch
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
| | - Lukasz Jodko
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Joanna Raszeja-Wyszomirska
- Hepatology and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Izabela Bania
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | | | - Dimitrios Bogdanos
- Institute of Liver Studies, School of Medicine, King’s College Hospital, London, UK
| | | | - Piotr Milkiewicz
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
- Hepatology and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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The impact of osteoporosis on health-related quality of life in patients after liver transplantation - a pilot study. GASTROENTEROLOGY REVIEW 2016; 10:215-21. [PMID: 26759628 PMCID: PMC4697035 DOI: 10.5114/pg.2015.52343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 12/12/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
Abstract
Introduction Liver transplantation (LT) is now a well-established procedure with 5-year survival rates over 70%, and one of its ultimate goals is the improvement of patient health-related quality of life (HRQOL). Osteoporosis remains a serious potential complication of LT, leading to fragility fractures, pain, and functional impairment. Aim To assess the degree of osteoporosis and the impact of fragility fractures on HRQOL in patients with chronic liver diseases treated with LT. Material and methods Twenty-seven patients (14 female, 13 male) at a median period of 3.5 years post LT participated in the study. HRQOL was assessed by Short Form-36 and PBC-40 instruments. Bone mineral density (BMD) in the lumbar spine and hip neck were measured by dual-energy X-ray absorptiometry. Physical activity was assessed by questionnaire. Data on the duration of the liver disease, time from LT, and fragility fractures were also collected. Results As many as 74.1% of the patients had reduced BMD (t-score < -1.0 SD) in the hip. Mean values of the spine and hip BMD z-scores were -1.1 and -0.9 SD, respectively. Time after LT, percentage of lean tissue, and physical activity were positively associated with BMD. The prevalence of fractures was 48%. We did not find significant differences in age, gender, body composition parameters, physical activity, BMD, and HRQOL scores between the subjects with and without fractures. Conclusions We found a high prevalence of fragility fractures and a decreased BMD in LT recipients. Patients with a history of fractures had similar HRQOL scores to those without fractures.
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Kallwitz ER. Sarcopenia and liver transplant: The relevance of too little muscle mass. World J Gastroenterol 2015; 21:10982-10993. [PMID: 26494955 PMCID: PMC4607898 DOI: 10.3748/wjg.v21.i39.10982] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/09/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023] Open
Abstract
Loss of muscle mass and function is a common occurrence in both patients with decompensated cirrhosis and those undergoing liver transplantation. Sarcopenia is associated with morbidity and mortality before and after liver transplantation. The ability of skeletal muscle mass to recover after transplant is questionable, and long term adverse events associated with persistent sarcopenia have not been well studied. Limited data is available examining mechanisms by which decreased muscle mass might develop. It is not clear which interventions might reduce the prevalence of sarcopenia and associated health burdens. However, measures to either decrease portal hypertension or improve nutrition appear to have benefit. Research on sarcopenia in the liver transplant setting is hampered by differing methodology to quantify muscle mass and varied thresholds determining the presence of sarcopenia. One area highlighted in this review is the heterogeneity used when defining sarcopenia. The health consequences, clinical course and potential pathophysiologic mechanisms of sarcopenia in the setting of cirrhosis and liver transplantation are further discussed.
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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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Prevalence and predictors of sleep disturbance among liver diseases in long-term transplant survivors. Can J Gastroenterol Hepatol 2015; 29:440-4. [PMID: 26176212 PMCID: PMC4699607 DOI: 10.1155/2015/359640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with cirrhosis are known to experience sleep disturbance, which negatively impacts health-related quality of life. OBJECTIVE To assess the prevalence and predictors of sleep disturbance before and after liver transplantation (LT). METHODS Both pre- and post-LT patients were administered the Basic Nordic Sleep Questionnaire. The primary outcome was overall sleep satisfaction; the secondary outcomes were sleep latency and sleep duration. RESULTS Eighty-three patients participated pre-LT and 273 post-LT. Overall, participants having completed both pre- and post-LT questionnaires reported satisfactory sleep 61% of the time before LT and 65% of the time after LT. However, on review of all questionnaires, patients with alcoholic liver disease (ETOH) experienced dramatically less sleep disturbance (OR 0.13 [95% CI 0.03 to 0.60]) post-LT, whereas those with hepatitis C remained without improvement (OR 0.90 [95% CI [0.38 to 2.15]). On logistic regression, patients with ETOH had statistically less sleep satisfaction pre-LT (OR 5.8 [95% CI 1.0 to 40.5]) and significantly better sleep satisfaction post-LT (OR 0.50 [95% CI 0.20 to 1.00]) compared with those with hepatitis C. In addition, both ETOH and other conditions had significantly better sleep latency than hepatitis C patients. CONCLUSIONS Sleep parameters for patients who undergo LT for hepatitis C do not improve following LT as much as they do in patients transplanted for ETOH. Following LT, patients transplanted for ETOH are significantly more satisfied with their sleep than those transplanted for hepatitis C. Physicians should address and manage sleep quality after LT, so as to ultimately improve quality of life.
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Kotarska K, Raszeja-Wyszomirska J, Wunsch E, Chmurowicz T, Kempińska-Podhorodecka A, Wójcicki M, Milkiewicz P. Relationship Between Pretransplantation Liver Status and Health-Related Quality of Life After Grafting: A Single-Center Prospective Study. Transplant Proc 2014; 46:2770-3. [DOI: 10.1016/j.transproceed.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Maria da Silva R, Brunow de Carvalho W, Johnston C, Borba de Castro M, Manta Ferreira I, Patti CL, Anthero de Azevedo R, Miziara Gonzalez A, Moura Linhares M, Augusto Salzedas-Netto A. Functional capacity after pediatric liver transplantation: a pilot study. Pediatr Transplant 2014; 18:586-93. [PMID: 25039300 DOI: 10.1111/petr.12318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 11/30/2022]
Abstract
The prospective cross-sectional study investigated the 6MWT performance in pediatric group of liver transplant recipients (6-17 yr, median post-transplantation time of 22 months) and compared to the normal values obtained in healthy children as well as evaluated the reproducibility of the 6MWT. We analyzed the relationship between walked distance and the 6MWw, distance walked × body weight) with the anthropometric, clinical, and pulmonary functions. In post-transplanted group, the average walked distance was significantly shorter compared with control (687 ± 80 m vs. 511 ± 72 m, p < 0.001). The calculated ICC coefficient confirmed the reproducibility among tests. The Pearson correlation revealed that only walked distance in the 6MWT was moderately correlated with tidal volume. Conversely, the 6MWw was significantly correlated with age, weight, height, BMI, FVC, PEF rate, and volume expiratory. According to multiple regression analysis, age, VE and FVC factors explained 80% of the variance in the 6MWw. In conclusion, the pediatric liver transplant recipients' performance in the 6MWT is significantly lower than the values for healthy children of the same age. Notably, the 6MWw may provide relevant information, constituting an additional parameter in the determination of functional capacity.
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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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Dasarathy S. Posttransplant sarcopenia: an underrecognized early consequence of liver transplantation. Dig Dis Sci 2013; 58:3103-11. [PMID: 23912247 PMCID: PMC4066193 DOI: 10.1007/s10620-013-2791-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 07/02/2013] [Indexed: 02/06/2023]
Abstract
Liver transplantation is believed to reverse the clinical and metabolic abnormalities of cirrhosis. Reduced skeletal muscle mass or sarcopenia contributes to increased mortality and adverse consequences of cirrhosis. Failure of reversal of sarcopenia of cirrhosis after liver transplantation is not well recognized. Six temporally, geographically, and methodologically distinct follow-up studies in 304 cirrhotics reported conflicting data on changes in indirect measures of skeletal muscle mass after transplantation. Distinct measures of body composition but not skeletal muscle mass were used and did not focus on the clinical consequences of sarcopenia after transplantation. A number of studies reported an initial rapid postoperative loss of lean mass followed by incomplete recovery with a maximum follow-up of 2 years. Posttransplant sarcopenia may be responsible for metabolic syndrome and impaired quality of life after liver transplantation. Potential reasons for failure to reverse sarcopenia after liver transplantation include use of immunosuppressive agents [mammalian target of rapamycin (mTOR) and calcineurin inhibitors] that impair skeletal muscle growth and protein accretion. Repeated hospitalizations, posttransplant infections, and renal failure also contribute to posttransplant sarcopenia. Finally, recovery from muscle deconditioning is limited by lack of systematic nutritional and physical-activity-based interventions to improve muscle mass. Despite the compelling data on sarcopenia before liver transplantation, the impact of posttransplant sarcopenia on clinical outcomes is not known. There is a compelling need for studies to examine the mechanisms and consequences of sarcopenia post liver transplantation to permit development of therapies to prevent and reverse this disorder.
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Affiliation(s)
- Srinivasan Dasarathy
- Department of Gastroenterology, Hepatology and Pathobiology, Cleveland Clinic, Lerner Research Institute, NE4 208, 9500 Euclid Avenue, Cleveland, OH, 44195, USA,
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Parsa Yekta Z, Tayebi Z, Shahsavari H, Ebadi A, Tayebi R, Bolourchifard F, Rafii F. Liver transplant recipients quality of life instrument: development and psychometric testing. HEPATITIS MONTHLY 2013; 13:e9701. [PMID: 24348643 PMCID: PMC3842516 DOI: 10.5812/hepatmon.9701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 08/25/2013] [Accepted: 09/11/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver transplantation is a life-saving intervention for many patients with end-stage liver disease. In the past, evaluation of successful liver transplantation was based on patients' survival rate. However, in recent years this evaluation has been based on patients' quality of life. Various instruments have been developed to evaluate patients' quality of life. Nonetheless, scholars still believe that it is crucial to develop a standardized and disease specific instrument for evaluating the quality of life in liver transplant recipients. OBJECTIVES The aim of this paper was to describe the development and psychometric testing process of a quality of life instrument specific to liver transplant recipients. MATERIALS AND METHODS Initial items of this instrument were extracted from a conventional content analysis study, and then were completed with findings of related international literature. The face validity was assessed by interviewing with four liver transplant recipients, and the content validity was evaluated by eleven experts in the field of transplantation. The construct validity was achieved by involving 250 liver transplant recipients through exploratory factor analysis method, and reliability was calculated by Cronbach's alpha. RESULTS Three main factors with 40 items were extracted from the exploratory factor analysis: Health Satisfaction, Concerns, and Complications. Reliability of the instrument was confirmed (alpha = 0.922). CONCLUSIONS Given the special considerations regarding liver transplant recipients, this questionnaire is more accurate in evaluating the success of liver transplantation.
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Affiliation(s)
- Zohreh Parsa Yekta
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Zahra Tayebi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Zahra Tayebi, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran, Tel: +98-2161054202, Fax: +98-2166904252, E-mail:
| | - Hooman Shahsavari
- Department of Nursing and Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Abbas Ebadi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Razieh Tayebi
- Depatment of Educational Psychology, Faculty of Psychology, Kharazmi University, Karaj, IR Iran
| | - Fariba Bolourchifard
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Forough Rafii
- Centre of Nursing Care Research, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, IR Iran
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Togashi J, Sugawara Y, Akamatsu N, Tamura S, Yamashiki N, Kaneko J, Sakamoto Y, Aoki T, Hasegawa K, Kokudo N. Quality of life after adult living donor liver transplantation: A longitudinal prospective follow-up study. Hepatol Res 2013; 43:1052-63. [PMID: 23369201 DOI: 10.1111/hepr.12060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/23/2012] [Accepted: 12/25/2012] [Indexed: 12/15/2022]
Abstract
AIM Patient survival after living donor liver transplantation (LDLT) has improved, but improvement of the health-related quality of life (HRQOL) of LDLT recipients is also an important issue. The aim of this study was to assess the HRQOL of LDLT recipients from the preoperative period to 18 months following transplantation by prospectively evaluating Short Form-36 Version 2 (SF-36v2) scores. METHODS Complete longitudinal SF-36v2 scores were collected from 35 consecutive LDLT recipients prior to surgery and at 3, 6, 12 and 18 months after transplantation. RESULTS HRQOL scores were severely impaired in all dimensions preoperatively. Although the scores improved significantly up to 18 months after transplantation, they remained lower than those of healthy controls in the majority of domains. Impaired scores preoperatively were significantly associated with severity of liver disease represented by a higher Model for End-Stage Liver Disease (MELD) score and Child-Turcotte-Pugh class C, and scores in such patients improved significantly after LDLT in every dimension at 12 months, indicating that the greater the impairment at the pretransplant stage, the greater the improvement in both physical and mental conditions. Preoperative lower HRQOL scores and higher MELD scores were independently associated with significant physical and mental score gains during the first year after LDLT. CONCLUSION The findings of the present study may facilitate the development of measures aimed at improving recipient's post-transplant life and establishing realistic expectations for LDLT recipients.
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Affiliation(s)
- Junichi Togashi
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Tokyo, Japan
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Quality of life and psychological distress of adult recipients after living donor liver transplantation. Transplant Proc 2013; 45:281-5. [PMID: 23375316 DOI: 10.1016/j.transproceed.2012.05.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/16/2012] [Indexed: 02/05/2023]
Abstract
This longitudinal prospective study evaluated health-related quality of life (HRQoL) and psychological distress among recipients after right-lobe adult-adult living donor liver transplantation (LDLT). We measured HRQoL among 81 consecutive recipients using the Chinese version of the Medical Outcomes Study Short Form-36 (SF-36). Psychological symptoms were measured using the Symptom Checklist-90-Revised (SCL-90-R). Clinical data were collected from Chinese Liver Transplant Registry records. Sixty-two recipients completed follow-up assessments at 6, 12, 24, and 36 months posttransplantation. SF-36 domain scores were lowest at 6 months, especially for role-physical, bodily pain, vitality, social functioning, role-emotional and mental component summary scale scores. They improved dramatically in the first year posttransplantation. None of the SF-36 domain scores differed significantly between 12 and 24 months. No SCL-90-R dimension score differed significantly among the four assessments (P > .05). Mental component summary scale scores significantly correlated with all four SCL-90-R global severity index scores (P < .05). HRQoL improved significantly in adult recipients in the first year after LDLT, but not thereafter. Patients recovered psychological well-being quickly after transplantation; this factor had an important influence on the HRQoL of LDLT recipients.
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Lemyze M, Dharancy S, Wallaert B. Response to exercise in patients with liver cirrhosis: implications for liver transplantation. Dig Liver Dis 2013; 45:362-6. [PMID: 23137795 DOI: 10.1016/j.dld.2012.09.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/10/2012] [Accepted: 09/30/2012] [Indexed: 12/11/2022]
Abstract
End-stage liver cirrhosis is a systemic disease carrying a short-term desperate prognosis without liver transplantation. Given the discrepancy between the growing number of candidates and the limited available liver grafts, the pre-transplantation screening process has become a challenging task. Cardiopulmonary exercise testing, by measuring maximal oxygen consumption at peak exercise, provides a global integrative approach of the health status of an individual. In the setting of liver cirrhosis, decreased oxygen consumption at peak exercise may result from a combination of multiple extra-hepatic complications, including deconditioning, malnutrition-associated muscle weakness, anaemia, cirrhotic cardiomyopathy, and hepato-pulmonary syndrome for instance. In addition, oxygen consumption at peak exercise not only correlated with the severity of the liver disease, but it is also independently associated with survival following liver transplantation. The present article aims to review the numerous determinants of impaired aerobic capacity in patients with severe liver disease, and to discuss how useful is cardiopulmonary exercise testing as a critical tool in the pre-transplantation assessment of these patients.
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Affiliation(s)
- Malcolm Lemyze
- Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens, France.
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Quality of life, risk assessment, and safety research in liver transplantation: new frontiers in health services and outcomes research. Curr Opin Organ Transplant 2013; 17:241-7. [PMID: 22476225 DOI: 10.1097/mot.0b013e32835365c6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW In this review, we briefly summarize three fruitful, emerging areas in liver transplantation research, quality of life; risk assessment; and patient safety. Our goal is to highlight recent findings in these areas, with a call for increased integration of social scientists and transplant clinicians to address how best to shape policy and improve outcomes. RECENT FINDINGS After liver transplantation, recipients generally experience clinically significant, sustained improvement in their physical, social and emotional well being. However, a sizeable minority of patients do experience excess morbidity that may benefit from ongoing surveillance and/or intervention. There is growing body of research that describes risks associated with liver transplantation, which can be useful aids to better inform decision making by patients, clinicians, payers, and policy makers. In contrast, there has been a relative lack of empirical data on transplant patient safety vulnerabilities, placing the field of surgery in stark contrast to other high-risk industries, wherein such assessments inform continuous process improvement. SUMMARY Health services and outcomes research has grown in importance in the liver transplantation literature, but several important questions remain unanswered that merit programmatic, interdisciplinary research.
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Johnson BD, Mather KJ, Newcomer SC, Mickleborough TD, Wallace JP. Vitamin C prevents the acute decline of flow-mediated dilation after altered shear rate patterns. Appl Physiol Nutr Metab 2012; 38:268-74. [PMID: 23537017 DOI: 10.1139/apnm-2012-0169] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oscillatory and retrograde shear rate (SR) impairs endothelial function, potentially through shear-induced oxidative stress. We tested the hypothesis that acute vitamin C supplementation would prevent the attenuation of brachial artery flow-mediated dilation (FMD) after a period of augmented oscillatory and retrograde SR. Twelve healthy men (aged 26 ± 3 years) participated in two 30-min study visits in which one arm was subjected to increased oscillatory and retrograde SR, using 60 mm Hg of forearm cuff compression, and the contralateral arm served as the control. Subjects ingested capsules containing either placebo (sucrose) or vitamin C at 90 and 120 min (1000 mg total vitamin C) prior to cuff compression periods in a randomized placebo-controlled double-blind crossover study. Oscillatory and retrograde SR in the cuffed arms increased during the compression periods in the placebo and vitamin C study visits (p < 0.01 for both), with no difference between studies (p > 0.05). Antegrade SR remained unchanged throughout the compression periods (p > 0.05), and mean SR was lower in the cuffed arm than in the control arm for both study visits (p < 0.05). FMD decreased after cuff compression in the placebo cuffed arm (precompression vs. postcompression, 5.2% ± 1.4% vs. 3.5% ± 1.4%; p < 0.05), but remained unchanged after vitamin C therapy in the cuffed arm (precompression vs. postcompression, 5.3% ± 2.4% vs. 5.7% ± 2.6%; p > 0.05). No FMD changes were observed in the control arm for either study visit (p > 0.05). These data demonstrate that acute vitamin C supplementation prevents the attenuation of FMD due to altered SR patterns, suggesting that oxidative stress contributes to the oscillatory and retrograde SR-induced impairment of FMD.
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Affiliation(s)
- Blair D Johnson
- a Department of Kinesiology, Indiana University, Bloomington, IN 47405, USA
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37
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Cha JE, Yi MS. Comparison of Anxiety, Depression, and Quality of Life between Organ Transplant Candidates and Recipients. ACTA ACUST UNITED AC 2012. [DOI: 10.7475/kjan.2012.24.3.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Goetzmann L, Scholz U, Dux R, Roellin M, Boehler A, Muellhaupt B, Noll G, Wüthrich RP, Klaghofer R. Life Satisfaction and Burnout Among Heart, Lung, Liver, and Kidney Transplant Patients and Their Spouses. SWISS JOURNAL OF PSYCHOLOGY 2012. [DOI: 10.1024/1421-0185/a000079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: While a number of studies have dealt with the psychosocial consequences of transplantation for patients, we know comparatively little about the strains faced by their spouses. The present study investigates the psychosocial health of transplant patients and their spouses, as well as the link between these groups’ physical and psychosocial status, on the one hand, and their degree of burnout and level of life satisfaction on the other. Design: In a cross-sectional study, 121 patients and their spouses are surveyed by questionnaire following heart, lung, liver, or kidney transplant. Methods: The psychosocial parameters investigated in both patients and spouses are sense of coherence, quality of life, quality of the relationship, life satisfaction, and burnout. Results: Patients rate the quality of the relationship higher than their partners do, and they are more satisfied with the relationship than their spouses are (p < .001). Regression analyses show that patients’ life satisfaction is associated with quality of the relationship. Evidence of a full burnout syndrome can be found in three of the patients and two of the spouses. Burnout in the case of both patients and their partners is associated with limitations in one’s own sense of coherence and in one’s mental and physical health (multiple R2 = 0.79 for patients and 0.76 for spouses). Conclusion: Because of the importance of the couple’s relationship, psychosocial counseling should pay more attention to relationship satisfaction. Psychotherapeutic techniques should be used to improve the sense of coherence in both patient and spouse.
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Affiliation(s)
- Lutz Goetzmann
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken, Bad Segeberg, Germany
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Ordin YS, Dicle A, Wellard S. Quality of life in recipients before and after liver transplantation in Turkey. Prog Transplant 2011. [PMID: 21977888 DOI: 10.7182/prtr.21.3.pl837214k0276260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Liver transplantation has become the treatment of choice for patients with end-stage liver disease. Most studies show a positive effect on quality of life after liver transplantation, but most studies are based on data from Western countries and little is known about quality of life in liver transplant recipients in Turkey or other developing countries. OBJECTIVE To investigate liver transplant recipients' quality of life and factors affecting it, before and 3 months after transplantation in western Turkey. DESIGN Descriptive and comparative, with data collected prospectively. SETTING Two medical centers in Western Turkey. PATIENTS Sixty-five adult recipients of a liver transplant between May 15 and December 31,2007. INSTRUMENTS Quality of life was measured by using the Nottingham Health Profile Turkish version, and sociodemographic and clinical data were collected from patients' records. RESULTS Scores on all subscales of the Nottingham Health Profile differed significantly from before to after liver transplantation. The differences between the mean scores for quality of life before and after transplantation varied significantly with the patients' sex and disease severity.
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Affiliation(s)
- Yaprak S Ordin
- Surgical Nursing Department, School of Nursing, Dokuz Eylul University, Inciralti, Turkey.
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40
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Ordin YS, Dicle A, Wellard S. Quality of Life in Recipients before and after Liver Transplantation in Turkey. Prog Transplant 2011; 21:260-7. [DOI: 10.1177/152692481102100312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yaprak S. Ordin
- Dokuz Eylul University, Inciralti, Turkey (YSO, AD), University of Ballarat, Ballarat, Australia (SW)
| | - Aklime Dicle
- Dokuz Eylul University, Inciralti, Turkey (YSO, AD), University of Ballarat, Ballarat, Australia (SW)
| | - Sally Wellard
- Dokuz Eylul University, Inciralti, Turkey (YSO, AD), University of Ballarat, Ballarat, Australia (SW)
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Scott PJ. Occupational therapy services to enable liver patients to thrive following transplantation. Occup Ther Health Care 2011; 25:240-56. [PMID: 23899078 DOI: 10.3109/07380577.2011.600427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Transplantation is the only viable treatment for end-stage liver failure. With advances in biomedicine and surgical technique, survival rates have improved and current research is beginning to focus on patient-related outcomes such as of quality of life (QOL) and life satisfaction. However, attention to the rehabilitation needs of those patients whose lives are saved, is lagging. Pretransplantation, there are serious strains to role function and limitations to mental and physical capacity. Following transplantation, the ability to perform once easy familiar tasks is difficult for a prolonged recovery period. Within a year many people do well, others do not. Little has been done for this latter group. The purpose of this article is to systematically describe the contributions occupational therapy can make to the people struggling with the challenges faced during the transplantation process. The first part presents a framework for understanding the impact of end-stage liver disease, then the transplant, and the subsequent recovery through the combination of two frameworks: the International Classification of Functioning Disability and Health (ICF) and the Model of Human Occupation. The second part of this article will present the implications for occupational therapists throughout seven stages: (1) decline in health, (2) organ failure, (3) referral for transplantation, (4) the waiting period, (5) the transplant surgery, (6) recovery, and (7) return of health. Attention to the needs of transplant recipients who lack the adaptive skills to resume productive lifestyles has the capacity to improve participation outcomes for this population.
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Affiliation(s)
- Patricia J Scott
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana, USA
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Johnson BD, Padilla J, Harris RA, Wallace JP. Vascular consequences of a high-fat meal in physically active and inactive adults. Appl Physiol Nutr Metab 2011; 36:368-75. [DOI: 10.1139/h11-028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Habitually active adults (ACT) typically exhibit lower postprandial lipemia, a condition that may attenuate oxidative stress and endothelial dysfunction following a high-fat meal (HFM), compared with inactive adults (INA). Our objective was to compare triglycerides (TAG), superoxide dismutase activity (SOD), oxidative stress (thiobarbituric reactive substances; TBARS), and brachial artery flow-mediated dilation (FMD%) before and after an HFM challenge in ACT and INA. ACT (n = 7) and INA (n = 7) subjects were matched for body mass index, age, and sex. Plasma TAG, SOD, TBARS, and FMD% were measured at baseline and 4 h after an HFM challenge. TAG significantly increased following the HFM in INA (4.15 ± 3.79 mmol·L–1 vs. 8.07 ± 5.12 mmol·L–1) and in ACT (2.16 ± 0.55 mmol·L–1 vs. 3.24 ± 1.40 mmol·L–1). Baseline TBARS were greater in ACT and remained unchanged in response to the HFM in both INA (5.1 ± 2.7 mmol·L–1 vs. 6.9 ± 2.9 mmol·L–1) and ACT (8.6 ± 2.0 mmol·L–1 vs. 7.9 ± 1.9 mmol·L–1). ACT exhibited greater SOD than INA at baseline (8.6 ± 0.7 U·mL–1 vs. 7.8 ± 0.6 U·mL–1) and following the HFM (9.3 ± 1.2 U·mL–1 vs. 8.0 ± 0.7 U·mL–1). Postprandial FMD% was decreased in INA (9.1% ± 4.0% vs. 6.2% ± 3.4%), yet remained unchanged in ACT (7.9% ± 3.7% vs. 9.3% ± 3.2%). In conclusion, the differential responses following an HFM support the concept that habitual physical activity can attenuate the negative postprandial alterations that affect vascular health.
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Affiliation(s)
- Blair D. Johnson
- Clinical Exercise Physiology Laboratory, Department of Kinesiology, Indiana University, Bloomington, IN 47405, USA
| | - Jaume Padilla
- Department of Biomedical Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Ryan A. Harris
- Georgia Prevention Institute, Georgia Health Sciences University, Augusta, GA 30912, USA
| | - Janet P. Wallace
- Clinical Exercise Physiology Laboratory, Department of Kinesiology, Indiana University, Bloomington, IN 47405, USA
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Saab S, Bownik H, Ayoub N, Younossi Z, Durazo F, Han S, Hong JC, Farmer D, Busuttil RW. Differences in health-related quality of life scores after orthotopic liver transplantation with respect to selected socioeconomic factors. Liver Transpl 2011; 17:580-90. [PMID: 21506246 DOI: 10.1002/lt.22268] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
One of the current ultimate goals of orthotopic liver transplantation (OLT) is the improvement of patients' health-related quality of life (HRQOL). The purpose of this study was to look at the effects of socioeconomic and demographic differences on the short-term and long-term HRQOL outcomes of OLT recipients. Three hundred three adult OLT recipients who were seen at the University of California Los Angeles were administered the Medical Outcomes Study Short Form 36 (SF-36), the Chronic Liver Disease Questionnaire (CLDQ), and a demographic survey. A parsimonious model of 12 socioeconomic and demographic predictors was identified. Their simultaneous influence on each SF-36 and CLDQ HRQOL domain score was evaluated with multivariate linear regression and backward selection. Hepatitis C virus impaired HRQOL; this was shown in the SF-36 Vitality and Bodily Pain domains and in most CLDQ domains. Females experienced more HRQOL impairment only within the CLDQ Abdominal Symptoms domain. OLT recipients who were married had better SF-36 Role-Emotion domain scores. OLT recipients with more than 12 years of education had better SF-36 Physical Functioning scores. Employed OLT recipients had less HRQOL impairment; this was evidenced by better scores in multiple domains of the SF-36 and the CLDQ. OLT patients with health maintenance organization or preferred provider organization insurance had higher HRQOL scores within almost all SF-36 and CLDQ domains. Patients with a mix of public and private insurance had significantly higher HRQOL scores in comparison with those with only public insurance. Identifying patients at higher risk for worse HRQOL scores, less satisfaction with OLT results, and greater problems with fatigue or mental health stressors will assist transplant centers in using their medical teams to develop early interventions and multidisciplinary approaches to improve HRQOL outcomes after OLT.
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Affiliation(s)
- Sammy Saab
- Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA.
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Jin S, Yan L, Li B, Wen T, Zhao J, Zeng Y, Chen Z, Wang W, Xu M, Yang J, Luo Y, Wu H. Quality of life and psychologic distress of recipients after adult living-donor liver transplantation (LDLT)-A study from mainland China. Transplant Proc 2011; 42:2611-6. [PMID: 20832555 DOI: 10.1016/j.transproceed.2010.04.062] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 01/22/2010] [Accepted: 04/16/2010] [Indexed: 02/06/2023]
Abstract
This cross-sectional study investigated potential factors impacting quality of life in 125 recipients after living-donor liver transplantation (LDLT). Health-related quality of life (HRQoL) was measured by using the Chinese version of Medical Outcomes Study Short Form-36 (SF-36), and psychologic symptoms by using the Symptom Checklist-90-Revised (SCL-90-R). Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaire. A total of 102 recipients (81.6%) completed the questionnaires. All SF-36 domain scores (except the mental health score) were lower in the study than in the general population of Sichuan. The mental quality of life was significantly lower in female than in male subjects (P = .000). Regarding the role-physical (P = .016), social functioning (P = .000), and role-emotional (P = .004) domains, recipients >1 year after transplantation scored higher than those <1 year. Bodily pain scores were lower in recipients with prior acute liver failure than those with hepatic carcinoma or hepatic cirrhosis (P = .032). Social functioning was poorer in recipients with than in those without complications (P = .039). Mental component summary scale (MCS) scores and some of physical component summary scale (PCS) significantly correlated with symptom dimension scores of the SCL-90-R (P < .05). In conclusion, gender, time since transplant, etiology of disease, complications, occupation, and some psychologic symptoms were possible factors influencing postoperative HRQoL of LDLT recipients.
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Affiliation(s)
- S Jin
- Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China
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Bruns H, Krätschmer K, Hinz U, Brechtel A, Keller M, Büchler MW, Schemmer P. Quality of life after curative liver resection: A single center analysis. World J Gastroenterol 2010; 16:2388-95. [PMID: 20480524 PMCID: PMC2874143 DOI: 10.3748/wjg.v16.i19.2388] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate quality of life (QoL) after curative liver resection and identify variables associated with decreased QoL.
METHODS: From October 2001 to July 2004, 323 patients underwent liver resection. At 3-36 mo after discharge, 188 patients were disease free. QoL was assessed using the Short Form (SF)-12 Health Survey with mental and physical component scales (SF-12 MCS and PCS), supplemented with generic questions concerning pain and liver-specific items.
RESULTS: Sixty-eight percent (128/188) returned the questionnaire, which was completed in 75% (96/128) of cases. Median SF-12 PCS and MCS were 46.7 (interquartile range: 34.2-53.9) and 54.1 (42.8-58.2). Fifty percent were pain free with a median symptom score of 1.75 (1.38-2.13). PCS was higher after major hepatectomy [57% (55/96)] compared to minor resection (P = 0.0049), which represented an improved QoL. QoL was not affected by sex but by age compared to the general German population. MCS was higher after liver surgery for metastatic disease [55.9 (47.5-58.8)] compared to primary carcinoma [49.6 (36.5-55.1)] and benign disease [49.2 (37.7-56.3)] (P = 0.0317). There was no correlation between length of postoperative period and QoL. Pain, deficiencies in everyday life and a high symptom score significantly decreased MCS and PCS.
CONCLUSION: Most patients were only marginally affected even after major liver resection; however, minor complications were associated with decreased SF-12 MCS and PCS and need careful attention.
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Aerobic capacity in patients with chronic liver disease: Very modest effect of liver transplantation. Presse Med 2010; 39:e174-81. [PMID: 20202784 DOI: 10.1016/j.lpm.2009.09.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 09/12/2009] [Accepted: 09/25/2009] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Aerobic capacity is commonly impaired in patients with liver cirrhosis, as demonstrated by their low oxygen consumption at peak exercise (peak VO(2)). This impairment is correlated with the severity of the liver disease. We investigated the effect of orthotopic liver transplantation (OLT) alone on exercise capacity in this prospective study of patients with liver cirrhosis. METHOD Twenty liver transplant candidates, aged 27 to 61years, underwent resting pulmonary function tests, echocardiography, and incremental cardiopulmonary exercise testing (CPET) before OLT and 16.3 + or - 1.6months after OLT. RESULTS Following OLT, peak VO(2) increased by a mean of only 7.7% (from 63.4 to 71.1% of predicted value), and decreased in one-quarter of the patients. Cardiac function was normal before OLT and no changes in respiratory indicators followed OLT. Change in peak VO(2) after OLT (Delta peak VO(2)) was related to changes in hemoglobin level (r(2)=0.45, p=0.04), the stopping of beta-blocker therapy, and muscle impairment, as suggested by the correlation between Delta peak VO(2) and peak lactate concentration before OLT (r(2)=0.64, p<0.01). DISCUSSION Our study provides evidence of a very modest and inconsistent increase in aerobic capacity in liver transplant candidates after liver transplantation alone. This persistent impairment of exercise tolerance was principally of peripheral origin but anemia and beta-blocker treatment should be considered as major aggravating factors. Rehabilitation programs before and after transplantation may increase its benefits to these deconditioned liver transplant recipients in their daily lives.
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Bownik H, Saab S. The effects of hepatitis C recurrence on health-related quality of life in liver transplant recipients. Liver Int 2010; 30:19-30. [PMID: 19845850 DOI: 10.1111/j.1478-3231.2009.02152.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Orthotopic liver transplantation (OLT) remains the definitive treatment for hepatitis C (HCV). Although HCV is the number one indication for OLT in the USA, health-related quality of life (HRQOL) scores are consistently lower for HCV patients when compared with all OLT indications. HCV is unique in that 95% of transplanted patients experience virological recurrence of HCV hepatitis. Despite few physical manifestations of disease at the time of HCV recurrence, patients report an impaired quality of life and functional status compared with OLT recipients without recurrence. Studies show that patient knowledge of the diagnosis of recurrent HCV alone can negatively impact HRQOL. This suggests that patients perceive themselves as unwell and have significant changes in their mental and physical health despite the absence of disease-related complications. Multiple studies show that patients with HCV recurrence report significantly higher scores for depression, anxiety and psychological distress. However, only a limited number of studies have investigated the influence of gender, HCV genotype, or HCV antiviral treatment on the HRQOL of OLT recipients with HCV recurrence. This review article describes what is currently known about the impact of recurrent HCV on HRQOL specifically after OLT. Understanding modifiable factors on HRQOL after HCV recurrence in OLT patients can greatly aid in tailoring multidimensional interventions to improve patient HRQOL.
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Affiliation(s)
- Hillary Bownik
- Department of Medicine, University of California, Los Angeles, CA 90095, USA
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48
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Bownik H, Saab S. Health-related quality of life after liver transplantation for adult recipients. Liver Transpl 2009; 15 Suppl 2:S42-9. [PMID: 19876941 DOI: 10.1002/lt.21911] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
1. Pretransplantation health-related quality of life scores are affected by the etiology of liver cirrhosis, with hepatocellular and cholestatic etiologies having higher health-related quality of life scores than alcohol or viral hepatitis etiologies. 2. Posttransplantation health-related quality of life scores are not affected by the etiology of the original liver cirrhosis, but transplant recipient scores continue to remain significantly lower than those of healthy patient controls. 3. During the first 6 months after liver transplantation, the majority of physical and mental components of health-related quality of life scores improve, but these increases are not sustained in the long term. 4. At 1 year after liver transplantation, emotional and mental health-related quality of life scores begin to decrease. 5. During postoperative years 1 to 5, episodes of acute cellular rejection and patient age over 60 years decrease physical function and overall general health-related quality of life scores. 6. Beyond 5 years after orthotopic liver transplantation, age over 60, osteoporosis, and episodes of chronic rejection decrease health-related quality of life scores through decreases in the physical function and bodily pain domains. 7. Hepatitis C as an indication for liver transplantation is an independent factor in decreasing posttransplantation health-related quality of life scores. 8. Further studies are necessary that include a complete evaluation of the effects of gender, socioeconomic status, education, and ethnicity in order to better understand factors influencing post-liver transplantation health-related quality of life scores. 9. The development of a health-related quality of life assessment tool specific to transplantation could help us to more accurately assess factors (such as immunosuppression) that alter posttransplantation health-related quality of life.
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Affiliation(s)
- Hillary Bownik
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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Abstract
With improvements in patient and graft survival after liver transplantation, recipient quality of life (QOL) has become an important focus of patient care and clinical outcomes research. To provide a better understanding of the instruments used to assess QOL in the adult liver transplant population, we conducted a systematic review of the MEDLINE database and Cochrane library. Our review identified 128 relevant articles utilizing more than 50 different QOL instruments. Generic health status instruments are the most commonly used, and among them the Medical Outcomes Study Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Beck Depression Inventory (BDI) are the most prevalent. Few studies (16%) included targeted, disease-specific instruments. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Quality of Life questionnaire, the Liver Disease Quality of Life questionnaire, and the Chronic Liver Disease questionnaire are the most frequently employed targeted instruments; however, these instruments have been designed to assess QOL in patients with chronic liver disease rather than patients after liver transplantation. The present review focuses on the psychometric properties of the existing QOL instruments and discusses their individual strengths and limitations in evaluating liver transplantation recipients. The lack of a gold-standard QOL instrument for liver transplant recipients is an impediment to cross-study comparisons. We conclude that the development of a QOL instrument specifically for liver transplant recipients will improve QOL assessment in this population leading to a more nuanced understanding of the factors that influence transplant recipients' well-being.
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Affiliation(s)
- Colleen L. Jay
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Zeeshan Butt
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniela P. Ladner
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Anton I. Skaro
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Michael M. Abecassis
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
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Goetzmann L, Ruegg L, Stamm M, Ambühl P, Boehler A, Halter J, Muellhaupt B, Noll G, Schanz U, Wagner-Huber R, Spindler A, Buddeberg C, Klaghofer R. Psychosocial Profiles After Transplantation: A 24-Month Follow-Up of Heart, Lung, Liver, Kidney and Allogeneic Bone-Marrow Patients. Transplantation 2008; 86:662-8. [DOI: 10.1097/tp.0b013e3181817dd7] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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