Effects of a Physiotherapeutic Protocol in Respiratory Function,Aerobic Capacity and Quality of Life After Kidney Transplantation

Introduction

Chronic kidney disease can lead to dysfunction of the respiratory, cardiac, and musculoskeletal systems, altering the body's metabolism. Renal transplantation and hospital physiotherapy, through specific protocols, can improve these dysfunctions.

Anxiety Levels Observed in Candidates for Liver Transplantation

Introduction

Anxiety can be considered an emotional state that does not present itself at the same intensity in all patients, and can be classified into 3 levels: mild, moderate, and severe. The patient, upon entering the waiting list for transplantation, reflects on the decision taken, which leaves him constantly anxious about the idea of possible death.

Objective

This study had the aim of evaluating the degree of anxiety observed in orthotopic liver transplantation (OLT) candidates and whether there was a correlation between anxiety and etiologic diagnosis.

Methods

This study was a prospective study where the patients underwent psychological evaluation by Beck Anxiety Inventory (BAI). The anxiety level was minimal, mild, moderate, or severe. The Model for End-Stage Liver Disease (MELD) score and etiology were recorded.

Results

The level of anxiety found were as follows: 55% minimal, 27% mild, 12% moderate, and 7% severe. The correlation between level of anxiety and etiologic diagnosis showed that 71% of patients with alcoholic cirrhosis and 60% of those with liver cancer showed a minimal degree of anxiety and 27% of patients with autoimmune cirrhosis had severe anxiety.

Conclusion

We found that in patients with autoimmune hepatitis, the degree of anxiety was more pronounced. It is believed that the absence of physical symptoms is an important factor when observing anxiety in OLT candidates.     

Hepatopulmonary Syndrome among Cirrhotic Candidates for Liver Transplantation

This study assess of hepatopulmonary syndrome (HPS) prevalence and the influence of etiology among cirrhotic patients due to an alcoholic or viral etiology. We examined the records of patients were distributed as Group 1, alcoholic (n = 40) and Group 2, hepatic cirrhosis of viral etiology (n = 35). Hepatic cirrhosis status was estimated by CHILD and MELD scores. Presence of clinical ascites spell out was noted as well as size and diastolic functions of the cardiac chambers using two-dimensional transthoracic echocardiography in M mode and by Doppler. HPS was studied with agitated saline serum and intravenous contrast administration. HPS was considered to be present when serum or contrast passed to the left chamber before the 5th cardiac cycle. There was no significant differences among related to sex, age, cirrhosis status or ascites. HPS frequency was 35% in Group 1 versus 64.7% among Group 2-Patients (P = .01). Taking into account the results, we concluded that HPS frequency was related to cirrhotic etiology. Upon multivariate analysis a patients with cirrhosis from viral etiology showed significantly increased HPS frequency compared with those displaying cirrhosis of an alcoholic etiology.     

Relationship Between MELD Severity Score and the Distance Walked and Respiratory Muscle Strength in Candidates for Liver Transplantation

The model end-stage liver disease (MELD) severity scoring system is used in the allocation of organs for liver transplantation. However, there is no evidence of its relationship with the functionality and respiratory muscle strength in these patients. The aim of this study was to analyze the correlation of MELD with distance walked and respiratory muscle strength in patients awaiting liver transplantation. We performed a cross-sectional analysis of 24 individuals (16 male and 8 female) with mean age of 51.8 ± 10.4 years. The MELD score inversely correlated with the 6-minute walking test (6MWT) (r = −0.85; P < .001) and with the maximal inspiratory pressure (MIP) (r = −0.69; P < .001). In addition, there was a correlation between 6MWT and MIP (r = 0.77; P < .001). Thus, MELD scores can be considered to be effective tools to predict the functional capacity and respiratory muscle strength in candidates for liver transplantation.     

Impact of Adult Living Donor Liver Transplantation on Waiting Time Survival in Candidates Listed for Liver Transplantation

Studies comparing adult living donor liver transplantation to deceased donor liver transplantation have focused on post-transplant survival. Our aim was to focus on the impact of living donor liver transplant on waiting time mortality and overall mortality. We analyzed the affect of living donor liver transplantation on waiting time mortality and overall mortality (from listing until last follow up) in a cohort of 116 transplant candidates. Fifty-eight candidates who had individuals present as potential living donors (volunteer group) were matched by MELD score to 58 liver transplant candidates who did not have individuals present as a potential living donor (no volunteer group). Twenty-seven percent of candidates in the no volunteer group and 62% of candidates in the volunteer group underwent liver transplantation, p = 0.0003. One-year waiting list mortality for the volunteer group and no volunteer group was 10% and 20%, respectively, p = 0.03. Patient survival from the time of listing to last follow up was similar between the two groups. In our study group, living donor liver transplantation is associated with a higher rate of liver transplantation and lower waiting time mortality. In the era of living donor liver transplantation, estimates of patient survival should incorporate waiting time mortality.     

Oral Health and Quality of Life in Candidates for Liver Transplantation

Background

There is a gap in the scientific literature about the association between oral health and the health-related quality of life of patients on the liver transplantation waiting list. The aim of this work was to describe aspects of oral health and quality of life of patients on a liver transplantation waiting list.

Impact of Smoking Cessation in Donor Candidates for Living Donor Liver Transplantation

Background

The relationship between smoking cessation and weight gain is well recognized. Examining the link between smoking cessation and weight gain in donor candidates for living donor liver transplantation (LDLT) is an important topic because of the influence of weight gain on the liver. This study assessed body weight (BW) changes after smoking cessation in donor candidates for LDLT.

Objective Versus Subjective Assessment of Functional Status in Candidates for Liver Transplantation

Introduction

and aim. Poor functional status is associated with increased mortality in cirrhosis patients awaiting liver transplantation (LT); however, the optimal assessment of functional status remains unknown. This study sought to determine the relationship between 6-minute walk distance (6MWD) and Karnofsky Performance Status (KPS) and their association with waitlist mortality in LT candidates.

Shipping Impact on Liver Graft: Results of Liver Transplantation Program in Andalusia

Liver transplantation for the treatment of patients with advanced liver disease is organized according to a waiting list taking into account different criteria. The agreed distribution model in Andalusia assumes that sometimes an organ is extracted in a different province to that where the implantation is to be performed (shipping), which, therefore, increases the graft ischemic time. The aim of the present study was to determine whether transportation of the organ and being harvested by a team other than the implantation team have a negative effect on final patient survival.     

Liver Transplantation Using Low-Weight Recipients From a Graft Split Program

We present our experience with a split liver (SL) program shared with the children's liver transplantation (LT) program from 2 different hospitals in the use of partial grafts from cadaver donors in brain death. We describe an observational, retrospective study, which included patients who underwent a SL transplantation in our center between January 2006 and December 2012. Clinical variables were recorded of both donors and recipients and their data were analyzed using SPSS 19.0 software. Of a total of 204 LT, 4 (2%) patients were treated with a SL. The causes of LT were alcoholic cirrhosis in 2 cases, cryptogenic cirrhosis, and primary biliary cirrhosis (PBC). In all cases there was a temporary portocaval shunt. The confluence of the hepatic veins of the recipient was anastomosed to the donor vena cava and arterial anastomosis was performed. The reconstruction was hepato-choledochal in all cases. There were no cases of postreperfusion syndrome or vascular thrombosis and no retransplantation was necessary. Currently, 3 of the 4 cases are still alive. Death in the other patient was due to mesenteric ischemia. Our center has participated in the development of a protocol that considers the indication of this technique provided expert groups are involved in its development, regardless of hospital level. This will expand the pool of donors and partially solve the current problems with available grafting.     

The Effect of a Comprehensive Rehabilitation Program on Respiratory Function and Functional Capacity on Patients After 1 Month to Liver Transplantation

BackgroundPhysical exercise is prescribed in populations with chronic diseases, but data are scarce in the liver transplantation (LT) setting.ObjectiveThe aim of this study was to evaluate changes in forced expiratory volume in the first second, forced vital capacity, maximal inspiratory pressure, maximal expiratory pressure, 6-minute walking test (6MWT), 6-minute step test (6MST), Duke Activity Status Index, VO₂ (mL/kg/min), and health-related quality of life (in patients submitted to a rehabilitation program, comprising physical exercise training, breathing techniques, and educational sessions after LT.MethodsThis cohort study enrolled patients to an 8-week period of thrice weekly comprehensive supervised rehabilitation program after 1 month of LT. A nonrandomized control cohort of LT patients were selected to match the rehabilitation group based on specific demographic data and severity of disease.ResultsThe rehabilitation group, compared with the control group, showed a significant improvement in respiratory parameters (forced vital capacity [0.33L vs 0.13L,P < .01]); exercise capacity (6MWT and 6MST 71.1 vs 34.1 meters; and 30.5 vs 7.5 steps; respectively P < .01); Duke Activity Status Index scores and VO₂ (21.3 vs 10.2 and 9 vs 4.3; respectively P < .01); respiratory muscle strength (maximal inspiratory pressure 21.1 vs 15.1 cmH₂O and maximal expiratory pressure 21.2 vs 10.2 cmH₂O; P < .01); and quality of life (SF-36 physical component summary 12.4 vs 2.9 P < .01).ConclusionThese data suggest that improvements in physical fitness, respiratory parameters, and quality of life are achieved with a comprehensive rehabilitation program initiated early after LT.     

Initial two-year results of the Oregon Liver Transplantation Program

During the first 24 months of the Oregon Liver Transplantation Program, which began in October 1988, 94 patients were formally evaluated and 47 adults underwent 54 liver transplantations. Thirty-four percent of patients were veterans. The recipient operation lasted a mean of 7.4 hours (range: 4 to 16 hours). Veno-venous bypass was used routinely at first but selectively later (7 of the last 26 cases), resulting in reduced operating time. Hepatic artery reconstruction was end-to-end anastomosis in 52 cases and iliac conduit in 2. No arterial thrombosis occurred. Biliary reconstruction was choledochocholedochostomy in 83% and choledochojejunostomy in 17%. Biliary complications occurred in 28%. Operative mortality was 2%, and 1-year actual survival was 80%. Patients with hepatitis B fared worse, with four of six dying at a mean of 7.6 months. Overall, the median hospital stay was 30 days. Patients surviving more than 3 months had a mean Karnofsky score of 82%. No significant difference in outcome was noted in patients receiving prophylactic OKT3 monoclonal antibody (used in 45%) versus conventional immunosuppressive therapy. Overall, allograft rejection occurred in 55% of patients. Retransplantation was required in seven patients, three for primary graft nonfunction, two for uncontrolled rejection during induction therapy with OKT3, and two for graft failure secondary to recurrent hepatitis B.     

Liver Involvement in Patients With PiZZ‐Emphysema,Candidates for Lung Transplantation

Information about the prevalence and nature of liver disorders in adults with alpha1‐antitrypsin deficiency is scarce. At our center, systematic liver biopsy screening is part of the evaluation before lung transplantation (LT) in the emphysema patients with the PiZZ phenotype. Our aim was to report our experience with this prospective screening. Clinical, liver function, and imaging parameters as well as liver histology data were analyzed for 23 consecutive adult patients with PiZZ severe emphysema referred to our center for consideration of LT from 2006 to 2014. Overall 20 (87%) featured chronic liver disease characterized by a chronic inflammation and/or a significant portal fibrosis on histology. Two of the 23 patients (8.7%) had septal fibrosis according to the Metavir and Ishak scores and met our definition of severe chronic liver disease. They were both clinically asymptomatic with normal liver function tests. On abdominal ultrasonography, the liver appeared normal in one patient and with abnormal contours in the other. Our data indicate that in adults with PiZZ‐related emphysema being evaluated for LT, most patients had some histologic involvement. The prevalence of severe liver dysfunction is <10%.     

Laparoscopic Approach for Down-Staging in Hepatocellular Carcinoma Patients Who Are Candidates for Liver Transplantation

Introduction

The aim of this study was to assess the impact of laparoscopic thermoablation (LTA) and laparoscopic resection (LR) as neoadjuvant therapy before orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC).

Methods

From June 2005 to November 2010, 50 consecutive patients affected by HCC with liver cirrhosis were treated with LTA under ultrasound guidance or LR. Of them, 10 patients (mean age, 58.3 ± 5.59 years; male:female, 8:2) underwent OLT. They were mostly Child-Pugh class A (80%).

Results

A LTA of 12 nodules was achieved in 7 patients and an LR of 3 HCC nodules in the other 3 subjects. The mean length of surgery was 163 minutes (range; 60–370). The mean hospital stay was 6.1 days. Transient mild postoperative liver failure was reported in 1 case. Complete tumor necrosis was observed in 10 thermoablated nodules (83.3%) via spiral computerized tomographic scan at 1 month after treatment; the resected patients showed absence of recurrence. All patients underwent OLT after a mean interval of 7 months. The histology of the native liver showed complete necrosis in 9/12 thermoablated nodules (75%); a recurrence at surgical site occurred in 1 patient in the resection group.

Conclusions

Laparoscopic ultrasound can be used in potential OLTs candidates to accurately stage HCC in advanced cirrhosis with minimal morbidity. LTA and LR proved to be safe and effective techniques for HCC patients, representing a valid “bridge” to OLT.     

成人肝移植术后呼吸系统管理和功能监测

目的：探索肝移植术后呼吸功能监测维持的规律,提高肝移植术后管理质量,方法：分析5例原位肝移植病人在术后ICU期经历的呼吸系统并发症和常见问题,结果：4例肝移植术后出现各种呼吸道并发症9例次,包括肝肺综合征、胸腔积液、肺不张、肺充血、肺间质水肿、肺感染及呼吸道出血,结论：呼吸机的使用和呼吸的监控是肝移植术后管理的重要环节。了解肝移植术后呼吸系统病理生理学改变的规律和特殊性,对于患安全渡过ICU阶段至关重要。     

压力调节容量控制通气用于肝移植术后呼吸功能支持

目的 探讨肝移植术后更合适的机械通气模式.方法 选取20例肝移植术后患者随机单盲均分为压力调节容量控制(PRVCV)组和容量控制通气(CV)组,比较2组患者氧输送(DO2)、氧耗量(VO2)、氧摄取率(O2ER)、动静脉氧含量差[C(a-v)O2]以及心输出量(CO)、平均肺动脉压(mPAP)、平均动脉压(mABP)、氧交换指数(PaO2/FiO2)、肺泡-动脉氧分压差[P(A-a)O2]、肺内分流量(Qs/Qt)、气道峰值压(PIP)和气道平均压(mAB)的变化.结果 PRVCV组患者P(A-a)O2和Qs/Qt较CV组明显降低,分别为(101.42±28.07) mm Hg、(1.78±0.86)%和(136.76±39.13) mm Hg、(3.28±0.99)%,P＜0.05,P＜0.01;而C(a-v)O2和O2ER明显高于CV组,分别为(20.70±10.41) mm Hg、(16.34±9.79)%和(12.83±2.49) mm Hg、(9.37±1.83)%,P＜0.05.2组患者血流动力学和气道压力的差异无统计学意义(P＞0.05).结论 压力调节容量控制通气模式更适合肝移植术后患者呼吸支持.     

The Utility of Noninvasive Scoring Systems for Prediction of Hepatic Steatosis in Liver Transplantation Donor Candidates

BackgroundThe degree of liver steatosis is an important factor for donor selection in living donor liver transplantation. Multidetector computed tomography (MDCT) has long been used in many transplantation centers to determine donor liver steatosis. Noninvasive scoring methods based on laboratory tests have been investigated as potential methods for altering liver biopsy and imaging techniques in evaluating the liver steatosis. In this study, we assess the utility of several noninvasive methods for the evaluation of donor hepatosteatosis. In comparison, MDCT was used for the evaluation of liver steatosis.MethodsA total of 205 donor candidates with significant hepatosteatosis were included in the study and divided into 4 groups according to the degrees of steatosis as measured by MDCT (mild, mid- to moderate, moderate to severe, and severe). In comparison, the aspartate aminotransferase–platelet ratio index (APRI), nonalcoholic fatty liver disease fibrosis score, BARD score, and FIB–4 scores were calculated.ResultsThe diagnostic performance of APRI in prediction of all degrees of hepatosteatosis on MDCT was significantly higher (P < .01). The BARD score showed the second best performance (P = .018), whereas FIB–4 and nonalcoholic fatty liver disease fibrosis score were not correlated with degree of liver steatosis on MDCT.ConclusionSome noninvasive scoring methods including APRI and BARD score seem to be more beneficial for the detection of hepatic steatosis in donor candidates and may reduce the need for other invasive and expensive diagnostic techniques.     

Home Parenteral Nutrition Program and Referral of Potential Candidates for Intestinal and Multivisceral Transplantation in a Single Brazilian Center

Intestinal failure is a multifaceted condition that may require high-complexity treatment and a multidisciplinary program, including home parenteral nutrition therapy (HPNT) and intestinal transplantation. In this article, we profile a Brazilian single-center experience with 128 cases of HTPN followed for the last 30 years and appraise the referral for potential intestinal and multivisceral transplantation.     

Effects of a Domino Liver Transplantation Program on Patient Survival and Waiting List Time: A Single-Center Retrospective Study

Explanted livers from patients with familial amyloid polyneuropathy have often been used for domino liver transplantation (DLT). This has expanded the organ pool for liver transplantation. We evaluated the effects of a single-center DLT program on waiting list duration and patient survival. Liver transplants conducted from 2007 to 2017 were analyzed. Selected patients, all liver transplant candidates above the age of 60 years and patients with hepatocellular carcinoma, were offered DLT. Survival, time on waiting list, and operative factors were evaluated. The study group included 485 patients transplanted with grafts from deceased donors (conventional liver transplantation) and 149 patients who were offered and accepted a potential DLT, of whom 34 underwent DLT and 115 did not; these patients received a deceased donor graft (non-DLT). Five-year and overall estimated survival rates respectively were 79% and 54.4% for DLT and 67.6% and 46.7% for non-DLT (P = .67, log rank test). No differences were noted in survival (P = .816) or waiting times (P = 1.0) between DLT and non-DLT groups. As expected, survival time in the conventional liver transplantation group was longer (84.7% and 60.6%, P < .001). Donor age and ischemia time were significantly different between DLT and non-DLT (P < .001). DLT has enabled 6% additional transplantations without affecting waiting time or survival (34/600).