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Czarnecka K, Czarnecka P, Tronina O, Bączkowska T, Durlik M. MASH Continues as a Significant Burden on Metabolic Health of Liver Recipients. Transplant Proc 2024; 56:822-831. [PMID: 38403537 DOI: 10.1016/j.transproceed.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/04/2024] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Metabolic complications are a recognized health concern in liver transplant recipients that result in inferior patient-reported outcomes. Patients with MASH are known to be disproportionately affected by metabolic diseases compared to other indications for transplantation. PURPOSE The aim of this study was to investigate the incidence of metabolic abnormalities in liver recipients with specific focus on differences between patients transplanted for MASH and non-MASH-causes. PATIENTS AND METHODS An observational, monocentric, and retrospective analysis was performed. Patients who received a cadaveric-donor-liver transplant between 2010 and 2019 were eligible. RESULTS 282 patients were enrolled with a median age of 52 years (66.7% males). Metabolic dysfunction-associated steatohepatitis (MASH) led to liver transplant in 8.2% of cases. De-novo metabolic syndrome was diagnosed in 36% of the study population. Patients that underwent transplant owing to MASH showed significantly higher incidence of metabolic complications in both pre- and post-transplant period. Considerable differences were noted in the pattern of weight gain between patients transplanted for MASH and non-MASH patients. The MASH etiology (OR: 5.5; 95% CI: 1.624-22.868; P = .010), higher BMI at 1-year post-transplant (OR: 1.321; 95% CI: 1.214-1.449; P = <.001), and older age at transplant (OR: 1.038; 95% CI: 1.006-1.074; P = .022) were independently associated with new-onset metabolic syndrome in liver recipients. CONCLUSION Metabolic complications were prevalent in liver recipients. Liver recipients with underlying MASH significantly surpassed patients transplanted for other indications in terms of metabolic complications incidence and demonstrated an unfavorable trajectory of weight gain post-transplant.
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Affiliation(s)
- Kinga Czarnecka
- Department of Transplant Medicine, Immunology, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
| | - Paulina Czarnecka
- Department of Transplant Medicine, Immunology, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Olga Tronina
- Department of Transplant Medicine, Immunology, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Teresa Bączkowska
- Department of Transplant Medicine, Immunology, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplant Medicine, Immunology, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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2
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Pérez-Amate È, Roqué-Figuls M, Fernández-González M, Giné-Garriga M. Exercise interventions for adults after liver transplantation. Cochrane Database Syst Rev 2023; 5:CD013204. [PMID: 37204002 PMCID: PMC10201528 DOI: 10.1002/14651858.cd013204.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND The finding that exercise is inversely related to metabolic syndrome after transplantation is novel and suggests that exercise interventions might provide a means for reducing metabolic syndrome complications in liver transplantation recipients. The use of exercise for increasing the physical activity daily levels by more frequent, higher intensity, and longer duration of training sessions, or the sum of these components may be necessary to counteract the effects of the pretransplant reduced activity, metabolic disturbances, and post-transplant immunosuppression, as well as improve physical function and aerobic capacity following liver transplantation. Regular physical activity has a long-term positive impact on recovery following various surgical procedures including transplantation, giving people the opportunity to return to an active life with their families, in society, and in their professional life. Likewise, specific muscle strength training may attenuate the loss of strength after liver transplantation. OBJECTIVES To evaluate the benefits and harms of exercise-based interventions in adults after liver transplantation compared to no exercise, sham interventions, or another type of exercise. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 2 September 2022. SELECTION CRITERIA We included randomised clinical trials in liver transplantation recipients comparing any type of exercise with no exercise, sham interventions, or another type of exercise. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. all-cause mortality; 2. serious adverse events; and 3. health-related quality of life. Our secondary outcomes were 4. a composite of cardiovascular mortality and cardiac disease; 5. aerobic capacity; 6. muscle strength; 7. morbidity; 8. non-serious adverse events; and 9. cardiovascular disease post-transplantation. We assessed risk of bias of the individual trials using RoB 1, described the interventions using the TIDieR checklist, and used GRADE to assess certainty of evidence. MAIN RESULTS We included three randomised clinical trials. The trials randomised 241 adults with liver transplantation, of which 199 participants completed the trials. The trials were conducted in the USA, Spain, and Turkey. They compared exercise versus usual care. The duration of the interventions ranged from two to 10 months. One trial reported that 69% of participants who received the exercise intervention were adherent to the exercise prescription. A second trial reported a 94% adherence to the exercise programme, with participants attending 45/48 sessions. The remaining trial reported a 96.8% adherence to the exercise intervention during the hospitalisation period. Two trials received funding; one from the National Center for Research Resources (US) and the other from Instituto de Salud Carlos III (Spain). The remaining trial did not receive funding. All trials were at an overall high risk of bias, derived from high risk of selective reporting bias and attrition bias in two trials. The results on all-cause mortality showed a higher risk of death in the exercise group versus the control group, but these results are very uncertain (risk ratio (RR) 3.14, 95% confidence interval (CI) 0.74 to 13.37; 2 trials, 165 participants; I² = 0%; very low-certainty evidence). The trials did not report data on serious adverse events excluding mortality or non-serious adverse events. However, all trials reported that there were no adverse effects associated with exercise. We are very uncertain on whether exercise compared with usual care has a beneficial or harmful effect on health-related quality of life assessed using the 36-item Short Form Physical Functioning subscale at the end of the intervention (mean difference (MD) 10.56, 95% CI -0.12 to 21.24; 2 trials, 169 participants; I² = 71%; very low-certainty evidence). None of the trials reported data on composite of cardiovascular mortality and cardiovascular disease, and cardiovascular disease post-transplantation. We are very uncertain if there are differences in aerobic capacity in terms of VO2peak at the end of the intervention between groups (MD 0.80, 95% CI -0.80 to 2.39; 3 trials, 199 participants; I² = 0%; very low-certainty evidence). We are very uncertain if there are differences in muscle strength at end of the intervention between groups (MD 9.91, 95% CI -3.68 to 23.50; 3 trials, 199 participants; I² = 44%; very low-certainty evidence). One trial measured perceived fatigue using the Checklist Individual Strength (CIST). Participants in the exercise group showed a clinically important lower degree of fatigue perception than participants in the control group, with a mean reduction of 40 points in the CIST (95% CI 15.62 to 64.38; 1 trial, 30 participants). We identified three ongoing studies. AUTHORS' CONCLUSIONS Based on very low-certainty evidence in our systematic review, we are very uncertain of the role of exercise training (aerobic, resistance-based exercises, or both) in affecting mortality, health-related quality of life, and physical function (i.e. aerobic capacity and muscle strength) in liver transplant recipients. There were few data on the composite of cardiovascular mortality and cardiovascular disease, cardiovascular disease post-transplantation, and adverse event outcomes. We lack larger trials with blinded outcome assessment, designed according to the SPIRIT statement and reported according to the CONSORT statement.
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Affiliation(s)
- Èlia Pérez-Amate
- Medical Oncology, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Marta Roqué-Figuls
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Miguel Fernández-González
- Department of Physical Therapy, Faculty of Health Sciences (FCS) Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Maria Giné-Garriga
- Department of Physical Activity and Sport Sciences, Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Zhang D, Wang J, Tao Z, Shi Y, Wang H, Chang T, Jiang X, Li X. Factors influencing employment rates and states after liver transplantation in China: A multi-centre cross-sectional study. Nurs Open 2023; 10:2582-2592. [PMID: 36448338 PMCID: PMC10006614 DOI: 10.1002/nop2.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/06/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022] Open
Abstract
AIM The aim of this study was to assess employment rates and states and the factors influencing liver transplant recipients in China. DESIGN A cross-sectional study. METHODS A total of 212 liver transplant recipients were included in this study. Questionnaires for general situation information and the Hospital Anxiety and Depression Scale, Perceived Social Support Scale and Chronic Disease Self-Efficacy Scale were used. RESULTS Among the liver transplantation, 212 recipients were included in the study, 125 (59%) were employed after liver transplantation compared with 148 (69.8%) who were employed before liver transplantation. Among the 125 recipients that returned to work, only 38.2% thought their employment states were good before liver transplantation, while 81.6% thought that their employment states were good after liver transplantation. Gender, age and employment status before transplantation, aetiology of liver disease, number of physical activities, per capita monthly income, comorbidity and depression were significantly associated with return to work. Self-efficacy, social support, liver function and nature of work were significantly associated with employment state.
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Affiliation(s)
- Dan Zhang
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jing Wang
- Nursing Department, Tianjin First Central Hospital, Tianjin, China
| | - Zijun Tao
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Shi
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Huili Wang
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tiantian Chang
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoyu Jiang
- Nursing Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaofei Li
- Transplantation and Hepatobiliary Department, the First Hospital of China Medical University, Shenyang, Liaoning, China
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Bagheri Lankarani K, Honarvar B, Akbari M, Bozorgnia N, Rabiey Faradonbeh M, Bagherpour M, Nikeghbalian S, Shamsaeefar A, Malekhosseini SA. Quality of Life and Its Determinants in Liver Transplantation Candidates: A Missed Link in Liver Care Program during the Waiting Time for Liver Transplantation. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:227-235. [PMID: 35634527 PMCID: PMC9126895 DOI: 10.30476/ijms.2021.88302.1895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/08/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
Background The health-related quality of life (HRQOL) in the before liver transplantation (LT) stage has not been studied as much as that after the LT stage. We aimed to assess HRQOL and its determinants before the LT stage. Methods As a cross-sectional study, HRQOL of all adult patients (n=632) referred to the LT center of Shiraz, Iran in 2018-2019 were assessed. Demographic, socioeconomic, medical, and paraclinical data were requested. Physical (PCS) and mental (MCS) aspects of HRQOL were assessed using the SF36 questionnaire. Univariable, multivariable (linear regression), and confirmatory factor analysis were performed utilizing SPSS 20 and Mplus 6.1 software. P<0.05 was considered to be significant. Results The mean age of the patients was 47.6±12.3 years, while 414 (65.6%) were men, and the mean, score of the model for end-stage liver disease (MELD) was 18.36±5.58. The mean score of QOL, PCS, and MCS was 50.01±21.73, 46.23±23.23, and 53.78±23.91 (out of 100), respectively. Vitality had the most association with HRQOL, while role limitations had the lowest. The multivariable analysis revealed that unemployment (P<0.001), anemia (P=0.005), weight loss (P=0.005), diabetes mellitus (DM) (P=0.009), low MELD score (P=0.027), and drug use (P=0.03) were the significant determinants of HRQOL, respectively. Conclusion The present study showed that HRQOL in the LT candidates was at the intermediate level, while their PCS and MCS are at the low and moderate levels, respectively. Furthermore, physical performance, job status, anemia, weight loss, MELD score, DM, and drug use should be considered as the significant determinants of HRQOL in the LT candidates.
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Affiliation(s)
- Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Honarvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Akbari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naghmeh Bozorgnia
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Rabiey Faradonbeh
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Bagherpour
- Department of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Saman Nikeghbalian
- Shiraz Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shamsaeefar
- Shiraz Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Webb AN, Lester ELW, Shapiro AMJ, Eurich DT, Bigam DL. Cost-utility analysis of normothermic machine perfusion compared to static cold storage in liver transplantation in the Canadian setting. Am J Transplant 2022; 22:541-551. [PMID: 34379887 DOI: 10.1111/ajt.16797] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 01/25/2023]
Abstract
To estimate the incremental cost-effectiveness of a liver transplant program that utilizes normothermic machine perfusion (NMP) alongside static cold storage (SCS) compared to SCS alone (control). A Markov model compared strategies (NMP vs. control) using 1-year cycle lengths over a 5-year time horizon from the public healthcare payer perspective. Primary micro-costing data from a single center retrospective trial were applied along with utility values from literature sources. Transition probabilities were deduced using the retrospective trial cohort, local transplant data, and supplemented with literature values. Scenario and probabilistic sensitivity analysis (PSA) were conducted. The NMP strategy was cost-effective in comparison to the control strategy, which was dominated. The mean cost for NMP was $456 455 (2021 US$) and the control was $519 222. The NMP strategy had greater incremental quality-adjusted life years (QALYs) gains over 5 years compared to the control, with 3.48 versus 3.17, respectively. The overarching results remained unchanged in scenario analysis. In PSA, NMP was cost-effective in 63% of iterations at a willingness-to-pay threshold of $40 941. The addition of NMP to a liver transplant program results in greater QALY gains and is cost-effective from the public healthcare payer perspective.
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Affiliation(s)
- Alexandria N Webb
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Erica L W Lester
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Jobst S, Schaefer J, Kleiser C, Kugler C. A Systematized Review of Professional Employment Following Thoracic Transplantation. Prog Transplant 2022; 32:55-66. [PMID: 35006009 DOI: 10.1177/15269248211064883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Acknowledging the evolved landscape in thoracic transplantation, professional employment becomes an important outcome measure to quantify the success of this costly procedure. OBJECTIVE We aimed to assess rates of and characterize factors associated with professional employment in patients following thoracic transplantation, and create an evidence-base on the relationship between professional employment and relevant outcome parameters. METHODS We systematically searched Medline, Cinahl, and GoogleScholar to identify studies published between 1998 and 2021 reporting on professional employment following heart and lung transplantation. RESULTS Twenty-two studies from 11 countries with varying sample sizes (N = 27; 10 066) were included. Employment rates ranged from 19.7% to 69.4% for heart, and from 7.4% to 50.8% for lung transplant recipients. Most frequently reported positively associated factors with employment after transplant were younger age, higher education, and history of pretransplant employment. Longer duration of unemployment prior to transplantation and Medicaid coverage were the most frequently reported negatively associated factors. Relationships between professional employment and clinical outcomes included lower rates of acute and chronic rejection, less infection episodes, and better quality of life among working patients; one study reported a lower 5-year-mortality rate. Reasons not to work were "physical or mental health-related," "employment-related," "financial reasons," and "lifestyle choices." DISCUSSION Substantial proportions of patients following thoracic transplantation are not professionally employed, potentially diminishing the success of transplantation on individual and societal levels. Considering adverse clinical outcomes in employed transplant recipients were low, more efforts are needed to identify modifiable factors for employment in these populations.
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Affiliation(s)
- Stefan Jobst
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Jonas Schaefer
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Christina Kleiser
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Christiane Kugler
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
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Strategies to Improve Immune Suppression Post-Liver Transplantation: A Review. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2040042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Since the first liver transplantation operation (LT) in 1967 by Thomas Starzl, efforts to increase survival and prevent rejection have taken place. The development of calcineurin inhibitors (CNIs) in the 1980s led to a surge in survival post-transplantation, and since then, strategies to prevent graft loss and preserve long-term graft function have been prioritized. Allograft rejection is mediated by the host immune response to donor antigens. Prevention of rejection can be achieved through either immunosuppression or induction of tolerance. This leads to a clinical dilemma, as the choice of an immunosuppressive agent is not an easy task, with considerable patient and graft-related morbidities. On the other hand, the induction of graft tolerance remains a challenge. Despite the fact that the liver exhibits less rejection than any other transplanted organs, spontaneous graft tolerance is rare. Most immunosuppressive medications have been incriminated in renal, cardiovascular, and neurological complications, relapse of viral hepatitis, and recurrence of HCC and other cancers. Efforts to minimize immunosuppression are directed toward decreasing medication side effects, increasing cost effectiveness, and decreasing economic burden without increasing the risk of rejection. In this article, we will discuss recent advances in strategies for improving immunosuppression following liver transplantation.
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8
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Kastelz A, Fernhall B, Wang E, Tzvetanov I, Spaggiari M, Shetty A, Gallon L, Hachaj G, Kaplan B, Benedetti E. Personalized physical rehabilitation program and employment in kidney transplant recipients: a randomized trial. Transpl Int 2021; 34:1083-1092. [PMID: 33733479 DOI: 10.1111/tri.13868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
Kidney transplantation is the preferred treatment for kidney failure; however after transplant, reduced physical function, poor self-perceptions, and unemployment are common concerns that remain. This randomized controlled trial compared the effects of a 12-month exercise rehabilitation program (intervention) to standard care alone (control) in kidney transplant recipients. The exercise intervention consisted of a 2 day/week, 60-minute personalized, one-on-one, resistance-based exercise trainings. Eighty participants completed the study (52 intervention vs. 28 control). For individuals unemployed at baseline, there was a 52.3% increase in employment compared to 13.3 % increase in the control group after 12 months (P = <0.0001). For those already employed at baseline, 100% of individuals maintained employment in both groups after 12 months (P = 0.4742). For all comers, there was a positive trend for Global Physical Health (P = 0.0034), Global Mental Health (P = 0.0064), and Physical Function (P = 0.0075), with the intervention group showing greater improvements. These findings suggest the implementation of an exercise rehabilitation program postkidney transplant can be beneficial to increase employment for individuals previously unemployed, improve self-perceived health, physical function, and mental health, overall contributing to better health outcomes in kidney transplant recipients. (Clinicaltrials.gov number: NCT02409901).
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Affiliation(s)
- Alexandra Kastelz
- Department of Surgery, University of Illinois University at Chicago, Chicago, IL, USA
| | - Bo Fernhall
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Edward Wang
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Ivo Tzvetanov
- Department of Surgery, University of Illinois University at Chicago, Chicago, IL, USA
| | - Mario Spaggiari
- Department of Surgery, University of Illinois University at Chicago, Chicago, IL, USA
| | - Aneesha Shetty
- Internal Medicine Nephrology, Northwestern Medical Group, Chicago, IL, USA
| | - Lorenzo Gallon
- Internal Medicine Nephrology, Northwestern Medical Group, Chicago, IL, USA
| | | | - Bruce Kaplan
- Baylor Scott and White Health System, Corporate office, Dallas, TX, USA
| | - Enrico Benedetti
- Department of Surgery, University of Illinois University at Chicago, Chicago, IL, USA
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Helzberg JH, Dai R, Muir AJ, Wilder J, Lee TH, Martin JG, Kim CY, Ronald J. Socioeconomic Status Is Associated with the Risk of Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol 2021; 32:950-960.e1. [PMID: 33663923 DOI: 10.1016/j.jvir.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine whether socioeconomic status (SES) is associated with hepatic encephalopathy (HE) risk after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS This single-institution retrospective study included 368 patients (mean age = 56.7 years; n = 229 males) from 5 states who underwent TIPS creation. SES was estimated using the Agency for Healthcare Research and Quality SES index, a metric based on neighborhood housing, education, and income statistics. Episodes of new or worsening HE after TIPS creation, defined as hospitalization for HE or escalation in outpatient medical therapy, were identified from medical records. Multivariable ordinal regression, negative binomial regression, and competing risks survival analysis were used to identify factors associated with SES quartile, the number of episodes of new or worsening HE per unit time after TIPS creation, and mortality after TIPS creation, respectively. RESULTS There were 83, 113, 99, and 73 patients in the lowest, second, third, and highest SES quartiles, respectively. In multivariable regression, only older age (β = 0.04, confidence interval [CI] = 0.02-0.05; P < .001) and white, non-Hispanic ethnicity (β = 0.64, CI = 0.07-1.21; P = .03) were associated with higher SES quartile. In multivariable regression, lower SES quartile (incidence rate ratio [IRR] = 0.80, CI = 0.68-0.94; P = .004), along with older age, male sex, higher model for end-stage liver disease score, nonalcoholic steatohepatitis, and proton pump inhibitor use were associated with higher rates of HE after TIPS creation. Ethnicity was not associated with the rate of HE after TIPS creation (IRR = 0.77, CI = 0.46-1.29; P = .28). In multivariable survival analysis, neither SES quartile nor ethnicity predicted mortality after creation of a TIPS. CONCLUSION Lower SES is associated with higher rates of new or worsening HE after TIPS creation.
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Affiliation(s)
- James H Helzberg
- Department of Medicine, Duke University School of Medicine, Durham
| | - Rui Dai
- Duke University School of Medicine, Durham
| | - Andrew J Muir
- Department of Medicine, Duke University School of Medicine, Durham; Duke Clinical Research Institute, Duke University School of Medicine, Durham
| | - Julius Wilder
- Department of Medicine, Duke University School of Medicine, Durham; Duke Clinical Research Institute, Duke University School of Medicine, Durham
| | - Tzu-Hao Lee
- Department of Medicine, Duke University School of Medicine, Durham
| | - Jonathan G Martin
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University School of Medicine, Durham
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University School of Medicine, Durham
| | - James Ronald
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University School of Medicine, Durham.
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10
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Gunn KM, Skrabal Ross X, McLoughlin M, McDonald S, Olver I. The psychosocial experiences and supportive care preferences of organ transplant recipients and their carers who live in regional Australia. Aust J Rural Health 2021; 29:92-105. [PMID: 33550657 DOI: 10.1111/ajr.12693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is no evidence that being a rural or regional organ transplant recipient has adverse physical health outcomes post-surgery compared with those experienced by people living in cities, but the impact of living remotely from transplant centres on psychosocial outcomes has not been explored. OBJECTIVE To identify the social, emotional, psychological, spiritual, informational and practical issues associated with being a regionally based organ transplant recipient or carer and determine how support services could be improved for this group. DESIGN/ SETTING/ PARTICIPANTS Twenty-two purposively sampled adult Australians who lived outside metropolitan centres and had received an organ transplant (n = 15) or were the primary carer of someone who had received one (n = 7), participated in semi-structured, telephone interviews. Qualitative data were collected until data saturation was reached and were analysed using thematic analysis. RESULTS Five key themes (plus subthemes) were identified: (a) travelling for specialist transplant care takes a toll, (b) unique transplant-related psychological and emotional issues experienced before and after transplants, (c) caring for transplant recipients is a demanding role, (d) lay, peer and professional support, including rural general practitioners and accommodation facilities, help ease the burden, but (e) significant barriers to accessing transplant-focused psychosocial support exist. CONCLUSION Novel methods of delivering targeted, transplant-specific information and psychosocial care to rural transplant recipients and their carers, employers and rural health professionals require development and evaluation. Strategies might be delivered by peers or professionals via telehealth, telephone, social media or websites for example, depending on preferences and level of need.
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Affiliation(s)
- Kate M Gunn
- University of South Australia Cancer Research Institute, Adelaide, SA, Australia.,Department of Rural Health, Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Xiomara Skrabal Ross
- University of South Australia Cancer Research Institute, Adelaide, SA, Australia
| | | | - Stephen McDonald
- Australia & New Zealand Dialysis and Transplant Registry, South Australia Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
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11
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Chen X, Zhang Y, Yu J. Symptom Experience and Related Predictors in Liver Transplantation Recipients. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 15:8-14. [PMID: 33188944 DOI: 10.1016/j.anr.2020.11.001] [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: 03/20/2020] [Revised: 08/25/2020] [Accepted: 11/08/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Symptom experience after liver transplantation (LT) provides healthcare professionals with important information about the benefits and limitations of LT from patients' perspective. This study aims to explore the multidimensional symptom experience and analyze related predictive factors in LT recipients. METHODS This cross-sectional study evaluated the occurrence, frequency, intensity, and level of distress of 40 symptoms in 265 LT recipients. Stepwise multiple regression analysis was performed to analyze the influencing factors of symptom experience. RESULTS The analysis of patient-reported data indicated that the ten most common symptoms were fatigue (42.3%), frequent sleep interruptions (38.9%), difficulty falling asleep (35.9%), decreased memory (34.0%), dreaminess (29.8%), itch (28.7%), muscular weakness (26.4%), shortness of breath (25.3%), anxiety (24.5%), and hand tremor (21.9%). Patients were classified into four groups according to survival time (1-month, 2-6-month, 7-12-month, and >1-year groups) after LT, and the most common symptom was fatigue in the one-month and 2-6-month groups, difficulty falling asleep in the 7-12-month group, and decreased memory in the >1-year group. Type of the primary caregiver, complications, concerns about the decreased ability to perform household and outdoor activities, and concerns about being a burden to the family were predictors of symptoms burden. CONCLUSION LT recipients experienced complicated symptoms. In clinical practice, it is critical to integrate physicians, nurses, and social workers as a medical team to help LT recipients develop suitable coping strategies that can potentially address patients' concerns, increase the sense of confidence, and improve symptom outcomes.
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Affiliation(s)
- Xiao Chen
- Liver Disease Department, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yuxia Zhang
- Nursing Department, Zhongshan Hospital of Fudan University, Shanghai, China.
| | - Jingxian Yu
- Liver Disease Department, Zhongshan Hospital of Fudan University, Shanghai, China
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12
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Baker P, Coole C, Drummond A, Khan S, McDaid C, Hewitt C, Kottam L, Ronaldson S, Coleman E, McDonald DA, Nouri F, Narayanasamy M, McNamara I, Fitch J, Thomson L, Richardson G, Rangan A. Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. Health Technol Assess 2020; 24:1-408. [PMID: 32930659 PMCID: PMC7520717 DOI: 10.3310/hta24450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip and knee replacements are regularly carried out for patients who work. There is little evidence about these patients' needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. OBJECTIVES To develop an occupational advice intervention to support early recovery to usual activities including work that is tailored to the requirements of patients undergoing hip or knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks. DESIGN An intervention mapping approach was used to develop the intervention. The research methods employed were rapid evidence synthesis, qualitative interviews with patients and stakeholders, a prospective cohort study, a survey of clinical practice and a modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the intervention mapping process. SETTING Orthopaedic departments in NHS secondary care. PARTICIPANTS Patients who were in work and intending to return to work following primary elective hip or knee replacement surgery, health-care professionals and employers. INTERVENTIONS Occupational advice intervention. MAIN OUTCOME MEASURES Development of an occupational advice intervention, fidelity of the developed intervention when delivered in a clinical setting, patient and clinician perspectives of the intervention and preliminary assessments of intervention effectiveness and cost. RESULTS A cohort study (154 patients), 110 stakeholder interviews, a survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, a personalised return-to-work plan and co-ordination from the health-care team to support the delivery of 13 patient and 20 staff performance objectives. To support delivery, a range of tools (e.g. occupational checklists, patient workbooks and employer information), roles (e.g. return-to-work co-ordinator) and training resources were created. Feasibility was assessed for 21 of the 26 patients recruited from three NHS trusts. Adherence to the defined performance objectives was 75% for patient performance objectives and 74% for staff performance objectives. The intervention was generally well received, although the short time frame available for implementation and concurrent research evaluation led to some confusion among patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. LIMITATIONS Implementation and uptake of the intervention was not standardised and was limited by the study time frame. Evaluation of the intervention involved a small number of patients, which limited the ability to assess it. CONCLUSIONS The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention. FUTURE WORK The intervention warrants a randomised controlled trial to assess its clinical effectiveness and cost-effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure that adoption is sustained. STUDY REGISTRATION Current Controlled Trials ISRCTN27426982 and PROSPERO CRD42016045235. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 45. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Baker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Carol Coole
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sayeed Khan
- Make UK, The Manufacturers' Organisation, London, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David A McDonald
- Whole System Patient Flow Programme, Scottish Government, Edinburgh, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Nouri
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Iain McNamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Judith Fitch
- British Orthopaedic Association Patient Liaison Group, Royal College of Surgeons of England, London, UK
| | - Louise Thomson
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Faculty of Medical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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13
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San Martín-Valenzuela C, Borras-Barrachina A, Gallego JJ, Urios A, Mestre-Salvador V, Correa-Ghisays P, Ballester MP, Escudero-García D, Tosca J, Montón C, Ríos MP, Kosenko E, Felipo V, Tabares-Seisdedos R, Selva-Vera G, Montoliu C. Motor and Cognitive Performance in Patients with Liver Cirrhosis with Minimal Hepatic Encephalopathy. J Clin Med 2020; 9:E2154. [PMID: 32650464 PMCID: PMC7408738 DOI: 10.3390/jcm9072154] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/28/2022] Open
Abstract
Minimal hepatic encephalopathy (MHE) is associated with mild cognitive impairment and frailty. This study aims to identify cognitive and motor differences in cirrhotic patients with and without MHE, and the correlations between motor signs and cognitive performance. Gait, balance, hand strength and motor speed performance were evaluated in 66 cirrhotic patients (38 without and 28 with MHE, according to the Psychometric Hepatic Encephalopathy Score (PHES). Cognitive performance was measured with the Mini-Mental State Examination, Verbal Fluency Test, Aprendizaje Verbal España-Complutense Test (TAVEC), Wechsler Adult Intelligence Scale III, Hamilton Depression and Anxiety Rating Scale and Functioning Assessment Short Test (FAST). MHE patients performed worse than patients without MHE in cognitive and autonomous functioning, learning and long-term memory, and verbal fluency. The same pattern was found in gait, center of pressure movement, variability of hand strength performance and hand motor speed. In MHE patients, high correlations were found between balance and FAST test, gait velocity and verbal skills, hand strength variability and anxiety and depression, and motor speed and FAST and TAVEC. MHE patients showed worse motor and cognitive performance than patients without MHE. MHE patients could have impaired movement control expressed as bradykinesia, and this reduced motor performance could correlate with cognitive performance.
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Affiliation(s)
- Constanza San Martín-Valenzuela
- Unit of Personal Autonomy, Dependency and Mental Disorder Assessment, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.M.-V.); (A.B.-B.); (V.M.-S.); (R.T.-S.)
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain;
| | - Aroa Borras-Barrachina
- Unit of Personal Autonomy, Dependency and Mental Disorder Assessment, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.M.-V.); (A.B.-B.); (V.M.-S.); (R.T.-S.)
| | - Juan-José Gallego
- INCLIVA, Health Research Institute, 46010 Valencia, Spain; (J.-J.G.); (A.U.); (M.-P.B.)
| | - Amparo Urios
- INCLIVA, Health Research Institute, 46010 Valencia, Spain; (J.-J.G.); (A.U.); (M.-P.B.)
| | - Víctor Mestre-Salvador
- Unit of Personal Autonomy, Dependency and Mental Disorder Assessment, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.M.-V.); (A.B.-B.); (V.M.-S.); (R.T.-S.)
| | - Patricia Correa-Ghisays
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain;
- Faculty of Psychology, University of Valencia, 46010 Valencia, Spain
| | - María-Pilar Ballester
- INCLIVA, Health Research Institute, 46010 Valencia, Spain; (J.-J.G.); (A.U.); (M.-P.B.)
- Digestive Medicine Unit, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (D.E.-G.); (J.T.); (C.M.)
| | - Desamparados Escudero-García
- Digestive Medicine Unit, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (D.E.-G.); (J.T.); (C.M.)
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Joan Tosca
- Digestive Medicine Unit, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (D.E.-G.); (J.T.); (C.M.)
| | - Cristina Montón
- Digestive Medicine Unit, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (D.E.-G.); (J.T.); (C.M.)
| | - María-Pilar Ríos
- Digestive Service, Arnau de Vilanova Hospital, 46015 Valencia, Spain;
| | - Elena Kosenko
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia;
| | - Vicente Felipo
- Laboratory of Neurobiology, Príncipe Felipe Research Center, 46012 Valencia, Spain;
| | - Rafael Tabares-Seisdedos
- Unit of Personal Autonomy, Dependency and Mental Disorder Assessment, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.M.-V.); (A.B.-B.); (V.M.-S.); (R.T.-S.)
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain;
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Gabriel Selva-Vera
- Unit of Personal Autonomy, Dependency and Mental Disorder Assessment, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.M.-V.); (A.B.-B.); (V.M.-S.); (R.T.-S.)
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain;
- Unit of Psychiatry and Psychological Medicine, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
| | - Carmina Montoliu
- INCLIVA, Health Research Institute, 46010 Valencia, Spain; (J.-J.G.); (A.U.); (M.-P.B.)
- Department of Pathology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
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Chen CP, Chen YW, Chang KH, Huang SW, Wu CH, Escorpizo R, Stucki G, Liou TH. Clustering of functioning and disability profile based on the WHO disability assessment schedule 2.0 - a nationwide databank study. Disabil Rehabil 2020; 44:353-362. [PMID: 32525411 DOI: 10.1080/09638288.2020.1767703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To compare and cluster the health status and disability restrictions associated with eight major physiological functions of body systems, using functioning domains of WHO Disability Assessment Schedule 2.0.Design: Retrospective analyses of a nation-wide disability database.Setting: Population-based study.Participants: Records from patients >18 years of age with disability were obtained from the Taiwan Data Bank of Persons with Disability (July 2012-November 2017). Disability functioning profile of the following diagnosis were analyzed: stroke, schizophrenia, hearing loss, liver cirrhosis, chronic kidney disease, congestive heart failure, burn, head and neck cancer.Interventions: Not applicable.Main Outcome Measures: Demographic data, severity of impairment, and Disability Assessment Scale scores were obtained and analyzed. Radar charts were constructed using the WHO Disability Assessment Schedule 2.0. functioning domain score. Degree of similarity between any two given diagnosis was assessed by cluster analysis, comparing the Euclidean distances between radar chart data points among the six domains.Results: Based on cluster analysis of similarities between functioning domain profiles, the eight diagnoses were grouped into different disability clusters. Four clusters of disability were named according to the type restriction patterns: global-impact cluster (stroke); interaction-restriction cluster (schizophrenia, hearing loss); physical-limitation cluster, (liver cirrhosis, CKD, and congestive heart failure); and specific-impact cluster (burn, head and neck cancer). The rates of institutionalization and unemployment differed between the four clusters.Conclusion: We converted WHO Disability Assessment Schedule 2.0. functioning domain scores into six-dimensioned radar chart, and demonstrate disability restrictions can be further categorized into clusters according to similarity of functioning impairment. Understanding of disease-related disabilities provides an important basis for designing rehabilitation programs and policies on social welfare and health that reflect the daily-living needs of people according to diagnosis.Implication for RehabilitationThe use of radar charts provided a direct visualization of the scope and severity of disabilities associated with specific diagnoses.Diagnosis-related disabilities can be organized into clusters based on similarities in WHODAS 2.0 disability domain profiles.Knowledge of the characteristics of disability clusters is important to understand disease-related disabilities and provide a basis for designing rehabilitation.
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Affiliation(s)
- Chao-Pen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Wen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,Graduate institute of sports science, National Taiwan Sports University, Taoyuan, Taiwan
| | - Chien-Hua Wu
- Department of Applied Mathematics, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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15
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Åberg F. Quality of life after liver transplantation. Best Pract Res Clin Gastroenterol 2020; 46-47:101684. [PMID: 33158471 DOI: 10.1016/j.bpg.2020.101684] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 01/31/2023]
Abstract
Liver transplantation (LT) enables rapid transition from critical illness and poor prognosis back to health. After LT, health-related quality of life (HRQoL) generally becomes comparable to that of the general population, although some deficits in mainly physical domains are frequent. However, recipients continue to have symptoms related to immunosuppression, complications, and other things, which impact HRQoL and the recipient's ability to regain independence and re-establish function in everyday life. Less than half of LT recipients return to work. Reportedly, HRQoL seems to deteriorate slightly over the long-term, but still remains satisfactory. Physical fatigue is common, but recent studies show that structured exercise programs improve both fatigue and HRQoL. Emerging evidence also suggests that continued patient information, structured psychosocial support systems, and caregiver involvement might further help improve long-term HRQoL. More research is needed to gain better understanding of the factors affecting long-term HRQoL, and how to best improve HRQoL.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland; The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
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16
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Wesolowska-Gorniak K, Wojtowicz M, Gierus J, Czarkowska-Paczek B. The correlation of patients' anxiety after a liver or kidney transplantation with functional and self-reported work ability. Medicine (Baltimore) 2020; 99:e20108. [PMID: 32358401 PMCID: PMC7440135 DOI: 10.1097/md.0000000000020108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Organ transplantation has become the treatment of choice for end-stage organ failure, including renal and liver failure. The benefits of patient employment after transplantation are numerous, but factors determining the ability to work among these patients are not clearly defined. The growing interest in these factors has strong practical implications for organizations creating vocational rehabilitation programs. Given the interconnection between psychological and physical functioning in patients after transplantation, the present study examined the impact of anxiety on vocational rehabilitation and its relationship with functional tests. A total of 100 patients after liver or kidney transplantation underwent functional tests, including the 6-minute walking test and 30-second chair stand test (30"CST), and psychological tests, specifically the Inventory of Physical Activity Objectives, Work Ability Index, and State-Train Anxiety Inventory. Working ability was affected by psychological factors. State and trait anxiety exhibited inverse relationships with subjective readiness to occupational activity (P < .001, r = -.59 and P < .001, r = -.56, respectively). The level of anxiety was negatively related to the results of the 30"CST. State-Train Anxiety Inventory, State Anxiety subscale and State-Train Anxiety Inventory, State-Trait Anxiety subscale vs 30"CST: P < .001, r = -.43 P < .001, r = -.44). Thus, state and trait anxiety influence perceived work ability and partially functional status. These observations may indicate the potential benefits of including psychologists in interdisciplinary teams for physical and especially vocational rehabilitation of patients after liver or kidney transplantation.
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Affiliation(s)
| | - Monika Wojtowicz
- Department of Immunology, Transplantology, and Internal Diseases, Warsaw
| | - Jacek Gierus
- Clinic of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
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17
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Wesolowska-Gorniak K, Wojtowicz M, Gierus J, Wlodarczyk E, Federowicz M, Czarkowska-Paczek B. Multivariate analysis of biopsychosocial determinants of professional activity among patients after kidney or liver transplantation in Poland. BMJ Open 2019; 9:e029501. [PMID: 31292184 PMCID: PMC6624034 DOI: 10.1136/bmjopen-2019-029501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of the present study was to assess the employment rate among kidney and liver transplant recipients in Poland and identify the predictors of employment. SETTINGS The study was based on a self-prepared questionnaire containing five parts: demographic data and professional, medical, physical and psychological factors. This is a multicentre study involving four hospitals in Poland. PARTICIPANTS The investigated group consisted of 285 individuals (92 women and 185 men; 8 no sex given) aged between 18 and 45 years who underwent kidney or liver transplantation 1-5 years prior. Because of missing data, 279 questionnaires were considered regarding employment status after transplantation and 277 when sex differences were considered. RESULTS A total of 120 patients (43%) worked full-time, 42 (15%) part-time and 117 (42%) remained unemployed, with a higher employment rate post-transplantation among men than women (60% vs 55%, p=0.04). More women performed white collar work (74% vs 41%, p=0.0003) and had to modify their working position than men (22% vs 7%, p=0.0118). Factors determining employment after transplantation included higher level of education (OR=27.08; p=0.0096), employment 1 year prior to transplantation (OR=11.05; p<0.001) and good psychological adaptation (OR=4.23; p<0.001). Men working the year before transplantation had higher education (OR=9.66; p=0.0356). Among men, more kidney recipients worked compared with liver recipients (OR=3.567; p=0.0417). Among women, age determined employment status (OR=0.89; p=0.0234). CONCLUSION Higher education is the most important predictor of employment after transplantation. Therefore, rehabilitation programmes including vocational activity should be directed to increase the level of education, both pretransplantation and post-transplantation if possible.
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Affiliation(s)
| | - Monika Wojtowicz
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Gierus
- Clinic of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
| | - Elzbieta Wlodarczyk
- Department of Geriatrics, Collegium Medicum, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Magdalena Federowicz
- Department of Rehabilitation, Central Teaching Clinical Hospital in Warsaw, Warsaw, Poland
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18
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Vieux L, Simcox AA, Mediouni Z, Wild P, Koller M, Studer RK, Danuser B. Predictors of Return to Work 12 Months After Solid Organ Transplantation: Results from the Swiss Transplant Cohort Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:462-471. [PMID: 30145704 DOI: 10.1007/s10926-018-9804-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background Return to work with or after a chronic disease is not a very well understood process, influenced by a variety of personal, professional, societal and medical factors. The aim of this study is to identify predictors for return to work 12 months after a solid organ transplant applying a bio-psycho-social model. Methods This study is based on patients included in the Swiss Transplant Cohort Study, a national prospective multicentre cohort, who underwent a first solid organ transplant (kidney, liver, heart, lung). Bio-psycho-social factors were tested and predictors of return to work identified using logistic regression models. Results Among the 636 patients included in the study, 49.8% (317) were employed 12 months post-transplant. The major predictor for returning to work 12 months posttransplant was pre-transplant employment status (OR 10.8). Accordingly, the population was stratified in employed and not employed pre-transplant groups. Age, self-perceived health (6 months post-transplant) and the transplanted organ were significantly associated with post-transplant employment status in both groups. Return to work was influenced by education, depression (6 month post-transplant) and waiting time in the employed pre-transplant group and by invalidity pension in the not employed pre-transplant group. Conclusion Employment status pre-transplant being highly associated with employment status post-transplant, the process promoting return to work should be started well before surgery. Biomedical, psychological and social factors must be taken into account to promote return to work in transplanted patients.
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Affiliation(s)
- Laure Vieux
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Amira A Simcox
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Zakia Mediouni
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland.
| | - Pascal Wild
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Michael Koller
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
| | - Regina K Studer
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Brigitta Danuser
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
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19
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Wesolowska-Gorniak K, Gierus J, Wojtowicz M, Bugajska J, Czarkowska-Paczek B. Determinants of Professional Activity After Kidney and Liver Transplantation: Questionnaire Development and Validation. Transplant Proc 2019; 51:651-664. [PMID: 30979448 DOI: 10.1016/j.transproceed.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Organ transplantation is currently the treatment of choice in end-stage organ failure. Organ replacement therapy compensates for most of organ function loss and offers recipients the potential for an independent life; nevertheless, the employment rate after kidney or liver transplant is low vs the general population. The purpose of this study was to create a questionnaire for kidney and liver transplant patients that comprehensively assesses factors affecting employment among these people including demographic, physical, and psychosocial variables. MATERIAL AND METHODS The study was based on a self-prepared questionnaire developed by a team of specialists in the field of medicine, rehabilitation, psychology, and employment. The questionnaire contained 5 parts: demographic data, professional factors, medical factors, physical factors, and psychological factors. The normalization sample consisted of 64 individuals (women and men) aged between 18 to 45 years 1 to 5 years after kidney or liver transplant. The Determinants of Professional Activity after Kidney and Liver Transplantation Questionnaire (DPATQ) was developed based on descriptive statistics, Spearman ρ coefficient, principal component analysis, Cronbach α, and item response theory analysis. RESULTS The Cronbach α reliability coefficient for the psychological part reached 0.88. CONCLUSION The DPATQ is a new method for measuring post-transplant adaptation and other factors influencing employment status. It offers good psychometric reliability. The DPATQ may be useful in the preparation process of vocational rehabilitation programs or in research studying problems with employment after solid organ transplant.
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Affiliation(s)
| | - J Gierus
- Psychiatric Clinic, Medical University of Warsaw, Pruszkow, Poland
| | - M Wojtowicz
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - J Bugajska
- Central Institute for Labor Protection, National Research Institute, Warsaw, Poland
| | - B Czarkowska-Paczek
- Department of Clinical Nursing, Medical University of Warsaw, Warsaw, Poland.
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De Pasquale C, Veroux M, Pistorio M, Papotto A, Basile G, Patanè M, Veroux P, Giaquinta A, Sciacca F. Return to Work and Quality of Life: A Psychosocial Survey After Kidney Transplant. Transplant Proc 2019; 51:153-156. [DOI: 10.1016/j.transproceed.2018.04.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/21/2018] [Accepted: 04/13/2018] [Indexed: 02/07/2023]
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Does recipient work status pre-transplant affect post–heart transplant survival? A United Network for Organ Sharing database review. J Heart Lung Transplant 2018; 37:604-610. [DOI: 10.1016/j.healun.2018.01.1307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/28/2017] [Accepted: 01/24/2018] [Indexed: 11/19/2022] Open
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George LA, Lominadze Z, Kallwitz ER. Transplantation: Loyola university (Con) patient and graft survival outcome at 1 and 3 years posttransplant do not reflect the value of successful liver transplantation. Clin Liver Dis (Hoboken) 2018; 11:62-65. [PMID: 30992790 PMCID: PMC6385940 DOI: 10.1002/cld.670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/30/2017] [Accepted: 09/12/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Lauren A. George
- Division of Gastroenterology and NutritionLoyola University Medical CenterMaywoodIL
| | - Zurabi Lominadze
- Division of Gastroenterology and NutritionLoyola University Medical CenterMaywoodIL
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Waclawski ER, Noone P. Systematic review: impact of liver transplantation on employment. Occup Med (Lond) 2018. [PMID: 29534206 DOI: 10.1093/occmed/kqy015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The majority of liver transplant recipients survive long term after the procedure. Aim To assess if this positive outcome is associated with improved employment post-transplant. Methods A systematic review of publications between 2001 and 2016 was performed. A standard procedure was used to search for suitable publications from two databases (PubMed and EMBASE). Duplicates were removed and abstracts screened by both authors for possible inclusion. Possible suitable publications were obtained and examined for the presence of pre- and post-employment information. Full articles that had this information were reviewed by standard methodology for assessment of bias. Results A total of 162 individual abstracts were screened. Thirty-five full papers were reviewed and 13 papers included in the detailed review. Risk of bias was considered high due to low response rates, poor assessment of prognostic and confounding factors and varying definitions of employment. Heterogeneous data precluded meta-analysis. Eight studies focused on return to work as a primary outcome and five on quality of life with employment as a secondary outcome. Follow-up varied between 2 and 13 years. Rates of employment fell in all studies assessed. Employment rates ranged from 26 to 80% pre-transplant and 18 to 44% post-transplant. The proportion of those categorized as ill-health retired was 24% greater after orthotopic liver transplantation. Conclusions Improved survival after liver transplantation was not reflected in a return to employment and retirement was common. Areas for further study include interventions to minimize physical deconditioning, depression associated with lower employment rates and type of work available after transplant.
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Affiliation(s)
- E R Waclawski
- Department of Medicine-Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - P Noone
- Health Service Executive, Dublin North East, Central Occupational Health Department, Ardee, Irel
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Ridola L, Cardinale V, Riggio O. The burden of minimal hepatic encephalopathy: from diagnosis to therapeutic strategies. Ann Gastroenterol 2018; 31:151-164. [PMID: 29507462 PMCID: PMC5825945 DOI: 10.20524/aog.2018.0232] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022] Open
Abstract
Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy (HE). It affects the performance of psychometric tests focused on attention, working memory, psychomotor speed, and visuospatial ability, as well as electrophysiological and other functional brain measures. MHE is a frequent complication of liver disease, affecting up to 80% of tested patients. By being related to falls, an impairment in fitness to drive and the development of overt HE, MHE severely affects the lives of patients and caregivers by altering their quality of life and their socioeconomic status. MHE is detected in clinically asymptomatic patients using appropriate psychometric tests and neurophysiological methods that highlight neuropsychological alterations, such as video-spatial orientation deficits, attention disorders, memory, reaction times, electroencephalogram slowing, prolongation of latency-evoked cognitive potentials, and reduction in the critical flicker frequency. Several treatments have been proposed for MHE treatment, including non-absorbable disaccharides, poorly absorbable antibiotics such as rifaximin, probiotics and branched-chain amino acids. However, because of the multiple diagnosis methods, the various endpoints of treatment trials and the variety of agents used in trials, the treatment of MHE is not currently recommended as routine, but only on a case-by-case basis.
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Affiliation(s)
- Lorenzo Ridola
- Department of Medico-Surgical Sciences and Biotechnologies (Lorenzo Ridola, Vincenzo Cardinale), Sapienza University of Rome, Italy
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies (Lorenzo Ridola, Vincenzo Cardinale), Sapienza University of Rome, Italy
| | - Oliviero Riggio
- Department of Clinical Medicine (Oliviero Riggio), Sapienza University of Rome, Italy
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Rogal S, Shenai N, Kruckenberg K, Rosenberger E, Dew MA, DiMartini A. Post-transplant Outcomes of Persons Receiving a Liver Graft for Alcoholic Liver Disease. Alcohol Alcohol 2017; 53:157-165. [DOI: 10.1093/alcalc/agx100] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Shari Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA 15240, USA
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Neeta Shenai
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
| | - Katherine Kruckenberg
- University Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - Emily Rosenberger
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Clinical and Translational Science Institute, 401 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Clinical and Translational Science Institute, 401 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261
- Departments of Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, 4200 Fifth Avenue, Pittsburgh, PA 15260, USA
| | - Andrea DiMartini
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
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Beal EW, Tumin D, Mumtaz K, Nau M, Tobias JD, Hayes D, Washburn K, Black SM. Factors contributing to employment patterns after liver transplantation. Clin Transplant 2017; 31. [PMID: 28314069 DOI: 10.1111/ctr.12967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many liver transplant recipients return to work, but their patterns of employment are unclear. We examine patterns of employment 5 years after liver transplantation. METHODS First-time liver transplant recipients ages 18-60 years transplanted from 2002 to 2009 and surviving at least 5 years were identified in the United Network for Organ Sharing registry. Recipients' post-transplant employment status was classified as follows: (i) never employed; (ii) returned to work within 2 years and remained employed (continuous employment); (iii) returned to work within 2 years, but was subsequently unemployed (intermittent employment); or (iv) returned to work ≥3 years post-transplant (delayed employment). RESULTS Of 28 306 liver recipients identified during the study period, 12 998 survived at least 5 years and contributed at least 1 follow-up of employment status. A minority of patients (4654; 36%) were never employed, while 3780 (29%) were continuously employed, 3027 (23%) were intermittently employed, and 1537 (12%) had delayed employment. In multivariable logistic regression analysis, predictors of intermittent and delayed employment included lower socioeconomic status, higher local unemployment rates, and post-transplant comorbidities or complications. CONCLUSION Never, intermittent, and delayed employment are common after liver transplantation. Socioeconomic and labor market characteristics may add to clinical factors that limit liver transplant recipients' continuous employment.
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Affiliation(s)
- Eliza W Beal
- The Department of General Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dmitry Tumin
- The Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Khalid Mumtaz
- The Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Nau
- The Ohio Colleges of Medicine Government Resource Center, Columbus, OH, USA
| | - Joseph D Tobias
- The Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Don Hayes
- The Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kenneth Washburn
- The Department of General Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sylvester M Black
- The Department of General Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Pflugrad H, Tryc AB, Goldbecker A, Strassburg CP, Barg-Hock H, Klempnauer J, Weissenborn K. Hepatic encephalopathy before and neurological complications after liver transplantation have no impact on the employment status 1 year after transplantation. World J Hepatol 2017; 9:519-532. [PMID: 28443157 PMCID: PMC5387364 DOI: 10.4254/wjh.v9.i10.519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/23/2017] [Accepted: 03/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the impact of hepatic encephalopathy before orthotopic liver transplantation (OLT) and neurological complications after OLT on employment after OLT. METHODS One hundred and fourteen patients with chronic liver disease aged 18-60 years underwent neurological examination to identify neurological complications, neuropsychological tests comprising the PSE-Syndrome-Test yielding the psychometric hepatic encephalopathy score, the critical flicker frequency and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), completed a questionnaire concerning their occupation and filled in the short form 36 (SF-36) to assess health-related quality of life before OLT and 12 mo after OLT, if possible. Sixty-eight (59.6%) patients were recruited before OLT, while on the waiting list for OLT at Hannover Medical School [age: 48.7 ± 10.2 years, 45 (66.2%) male], and 46 (40.4%) patients were included directly after OLT. RESULTS Before OLT 43.0% of the patients were employed. The patients not employed before OLT were more often non-academics (employed: Academic/non-academic 16 (34.0%)/31 vs not employed 10 (17.6%)/52, P = 0.04), had more frequently a history of hepatic encephalopathy (HE) (yes/no; employed 15 (30.6%)/34 vs not employed 32 (49.2%)/33, P = 0.05) and achieved worse results in psychometric tests (RBANS sum score mean ± SD employed 472.1 ± 44.5 vs not employed 443.1 ± 56.7, P = 0.04) than those employed. Ten patients (18.2%), who were not employed before OLT, resumed work afterwards. The patients employed after OLT were younger [age median (range, min-max) employed 47 (42, 18-60) vs not employed 50 (31, 29-60), P = 0.01], achieved better results in the psychometric tests (RBANS sum score mean ± SD employed 490.7 ± 48.2 vs not employed 461.0 ± 54.5, P = 0.02) and had a higher health-related quality of life (SF 36 sum score mean ± SD employed 627.0 ± 138.1 vs not employed 433.7 ± 160.8; P < 0.001) compared to patients not employed after OLT. Employment before OLT (P < 0.001), age (P < 0.01) and SF-36 sum score 12 mo after OLT (P < 0.01) but not HE before OLT or neurological complications after OLT were independent predictors of the employment status after OLT. CONCLUSION HE before and neurological complications after OLT have no impact on the employment status 12 mo after OLT. Instead younger age and employment before OLT predict employment one year after OLT.
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Affiliation(s)
- Henning Pflugrad
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Anita B Tryc
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Annemarie Goldbecker
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Christian P Strassburg
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Hannelore Barg-Hock
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Jürgen Klempnauer
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Karin Weissenborn
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
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