Liver transplantation in the patient with physical frailty

Tandon, Puneeta; Zanetto, Alberto; Piano, Salvatore; Heimbach, J.; Dasarathy, Srinivasan

doi:10.1016/j.jhep.2023.03.025

Cited by 18 publications

(17 citation statements)

References 152 publications

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“…The current guidelines recommend bedside manual testing of muscle strength in awake and cooperative patients, whilst severity is scored using the Medical Research Council's (MRC's) variant sum-score [49]. The MRC's sum-score ranges between 0 and 60, and a score of <48 suggests ICU-AW.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Intensive Care Unit-Acquired Weakness after Liver Transplantation: Analysis of Seven Cases and a Literature Review

Gaspari,

Spinazzola,

Aceto

et al. 2023

JCM

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Intensive Care Unit (ICU)-Acquired Weakness (ICU-AW) is a generalized muscle weakness that is clinically detected in critical patients and has no plausible etiology other than critical illness. ICU-AW is uncommon in patients undergoing orthotopic liver transplantation (OLT). Our report sheds light on the highest number of ICU-AW cases observed in a single center on OLT patients with early allograft dysfunction. Out of 282 patients who underwent OLT from January 2015 to June 2023, 7 (2.5%) developed generalized muscle weakness in the ICU and underwent neurophysiological investigations. The neurologic examination showed preserved extraocular, flaccid quadriplegia with the absence of deep tendon reflexes in all patients. Neurophysiological studies, including electromyography and nerve conduction studies, showed abnormalities with fibrillation potentials and the rapid recruitment of small polyphasic motor units in the examined muscles, as well as a reduced amplitude of the compound muscle action potential and sensory nerve action potential, with an absence of demyelinating features. Pre-transplant clinical status was critical in all patients. During ICU stay, early allograft dysfunction, acute kidney injury, prolonged mechanical ventilation, sepsis, hyperglycemia, and high blood transfusions were observed in all patients. Two patients were retransplanted. Five patients were alive at 90 days; two patients died. In non-cooperative OLT patients, neurophysiological investigations are essential for the diagnosis of ICU-AW. In this setting, the high number of red blood cell transfusions is a potential risk factor for ICU-AW.

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Section: Literature Review and Discussionmentioning

confidence: 99%

Intensive Care Unit-Acquired Weakness after Liver Transplantation: Analysis of Seven Cases and a Literature Review

Gaspari,

Spinazzola,

Aceto

et al. 2023

JCM

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“… 10 , 44 Additionally, the presence of sarcopenia (surrogate of which could be the functional score) has been associated with poorer outcomes following liver transplantation; this is a concern for those with NASH/MASH as sarcopenia is known to be associated with an increase in mortality in that population. 45 – 48 Therefore, careful assessment and management of the comorbidities present in those with NASH/MASH is needed prior to liver transplant to maximize the chance for positive outcomes. As NASH-HCC is now the number one indication for liver transplantation among those with HCC, hepatology and transplantology experts will need to develop such management guidelines.…”

Section: Discussionmentioning

confidence: 99%

The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction–associated steatotic liver disease and alcohol-associated liver disease

Younossi,

Stepanova,

Al Shabeeb

et al. 2023

Hepatology Communications

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Background: The high prevalence of obesity in the United States drives the burden of NASH, recently renamed as metabolic dysfunction–associated steatohepatitis (MASH). We assessed the most recent trends in liver transplantation in the United States. Methods: The Scientific Registry of Transplant Recipients (SRTR 2013-2022) was used to select adult (18 years or above) candidates who underwent liver transplant. Results: There were 116,292 candidates who underwent liver transplant with known etiology of chronic liver disease. In candidates without HCC, the most common etiology was alcohol-associated liver disease (ALD), increasing from 23% (2013) to 48% (2022), followed by NASH/MASH, which increased from 19% to 27%; the rates of viral hepatitis decreased (chronic hepatitis C: 28%–4%; chronic hepatitis B: 1.8%–1.1%) (all trend p<0.01). The proportion of HCC decreased from 25% (2013–2016) to 17% (2021-2022). Among HCC cohort, the proportion of chronic hepatitis C decreased from 60% (2013) to 27% (2022), NASH/MASH increased from 10% to 31%, alcohol-associated liver disease increased from 9% to 24% (trend p<0.0001), and chronic hepatitis B remained stable between 5% and 7% (trend p=0.62). The rapid increase in the proportion of NASH/MASH in HCC continued during the most recent study years [20% (2018), 28% (2020), 31% (2022)]; the trend remained significant after adjustment for age, sex, ethnicity, obesity, and type 2 diabetes. Conclusions: Liver transplant etiologies in the United States have changed over the last decade. Alcohol-associated liver disease and NASH/MASH remain the 2 most common indications for transplantation among those without HCC, and NASH/MASH is the most common in patients with HCC.

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“…However, specifications for each parameter have not been completely defined for this population. In recent review articles, the authors proposed relevant, useful orientations based mostly on expert opinions[ 7 , 45 ]. An exercise prescription must contain aerobic training ( e.g., walking), resistance exercises for the lower and upper extremities ( e.g., functional - stairs - or progressive weight training) and flexibility or balance training ( e.g., stretching and balance exercises) and use the talk test to ensure adequate intensity throughout the training[ 7 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Exercise training as an intervention for frailty in cirrhotic patients on the liver transplant waiting list: A systematic review

Loschi,

Baccan,

Della Guardia

et al. 2023

World J Hepatol

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Patients with liver cirrhosis are advised to limit their sodium consumption to control excessive fluid accumulation. Salt is the most common form in which sodium is consumed daily. Consequently, various recommendations urge patients to limit salt intake. However, there is a lack of consistency regarding salt restriction across the guidelines. Moreover, there is conflicting evidence regarding the efficacy of salt restriction in the treatment of ascites. Numerous studies have shown that there is no difference in ascites control between patients with restriction of salt intake and those without restriction. Moreover, patients with cirrhosis may have several negative effects from consuming too little salt, although there are no recommendations on the lower limit of salt intake. Sodium is necessary to maintain the extracellular fluid volume; hence, excessive salt restriction can result in volume contraction, which could negatively impact kidney function in a cirrhotic patient. Salt restriction in cirrhotic patients can also compromise nutrient intake, which can have a negative impact on the overall outcome. There is insufficient evidence to recommend restricted salt intake for all patients with cirrhosis, including those with severe hyponatremia. The existing guidelines on salt restriction do not consider the salt sensitivity of patients; their nutritional state, volume status and sodium storage sites; and the risk of hypochloremia. This opinion article aims to critically analyze the existing literature with regard to salt recommendations for patients with liver cirrhosis and identify potential knowledge gaps that call for further research.

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Liver transplantation in the patient with physical frailty

Cited by 18 publications

References 152 publications

Intensive Care Unit-Acquired Weakness after Liver Transplantation: Analysis of Seven Cases and a Literature Review

Intensive Care Unit-Acquired Weakness after Liver Transplantation: Analysis of Seven Cases and a Literature Review

The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction–associated steatotic liver disease and alcohol-associated liver disease

Exercise training as an intervention for frailty in cirrhotic patients on the liver transplant waiting list: A systematic review

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