Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Liver Transplantation

Abstract

Background: Postoperative respiratory complications (PRCs) are common after liver transplantation (LT) and contribute significantly to the related morbidity and mortality. Objective: The aim of this paper was to determine the incidence of PRCs after LT and the value of simple exercise capacity measures as independent predictors of PRCs. Methods: We conducted a prospective cohort study of consecutive adults submitted to LT at a University Hospital in Fortaleza Brazil from March 2013 to March 2015. At baseline, exercise capacity was assessed with the 6-minute walk test (6MWT) and the 6-minute step test (6MST), lung function was tested by spirometry, and respiratory muscle strength was measured by maximal respiratory pressure. Additional relevant pre- and intraoperative data were collected through interview and chart review, and their association with the incidence of PRCs was evaluated. Results: The study included 100 subjects, 44% of whom presented at least 1 of the PRCs. In the univariate analysis, poor 6MST and 6MWT results and a longer preoperative cold ischemia time were associated with PRCs. The logistic regression analysis showed that PRCs were less likely to occur when preoperative walking distances were longer: the odds ratio (95% CI) was reduced to 0.589 (0.357-0.971) for each 50 m walked (p = 0.03). Likewise, PRCs were more likely to occur in patients with longer preoperative cold ischemia times: the odds ratio (95% CI) increased to 1.008 (1.002-1.015) for each minute (p = 0.01). Conclusion: The incidence of PRCs is high in LT patients. A prolonged cold ischemia time and preoperative 6MWT results were independent predictors of PRCs in this patient population.

Retrospective Comparative Study on Postoperative Pulmonary Complications After Orthotopic Liver Transplantation Using the Melbourne Group Scale (MGS-2) Diagnostic Criteria

“…Therefore, any factor associated with dysfunction of normal lung endothelial-epithelial barriers or any other pulmonary abnormality is currently considered as a PPC in accordance with the broad diagnostic criteria [ 4 ]. In line with previous results [ 9 – 11 ], we also found that non-infectious pulmonary abnormalities, including pleural effusion and atelectasis, were the most frequent respiratory disorders after OLT. These non-infectious PPCs might be related to surgical maneuvers and have been reported to be usually self-limiting and respiratory physiotherapy might be unnecessary [ 6 , 11 ].…”

“…Postoperative pulmonary complications (PPCs) after orthotopic liver transplantation (OLT) – especially those occurring within the first month after surgery – are significantly associated with poor postoperative survival [ 1 ]. Using conventional broad criteria for diagnosis of PPCs, any postoperative pulmonary abnormality that adversely affects the clinical course of a patient could be defined as a PPC, including respiratory failure, pneumonia, atelectasis, pneumothorax, pleural effusion, acute lung injury (ALI), acute respiratory distress syndrome (ARDS), and various other forms of upper airway obstruction [ 2 – 4 ].…”

Association Between Fatigue and Exercise Capacity in Patients With Chronic Liver Disease Awaiting Liver Transplantation

“…This was a cross-sectional study of 100 adult ESLD patients undergoing pretransplantation assessment at a teaching hospital in Brazil between July 2015 and July 2017. Previous studies found correlations between exercise capacity and fatigue in chronic diseases (6,7) . This sample size calculation was based on the hypothesis that functional exercise capacity was at least well correlated with fatigue.…”

“…Patients with cirrhosis are reported to have significantly lower 6MWT values than individuals with stable chronic viral hepatitis, or healthy volunteers (5) . In a cohort study with 100 patients submitted to liver transplantation, Magalhães et al found 6MST and 6MWT to be associated with postoperative respiratory complications (6) .…”

Fatigue and Physiotherapy In Liver Transplant Recipients Fatigue and Physiotherapy

“…Fatigue has been listed as the most commonly experienced symptom in patients with chronic liver disease (5); it leads to complications, adversely affecting results of liver transplantation as well as survival (6,7). Ney et al reported that the level of physical activity which is reported by the subjects who have liver failure was low and the major barrier was fatigue (8).…”