Systematic review: pre‐ and post‐operative prognostic value of cardiopulmonary exercise testing in liver transplant candidates

Ney, Michael; Haykowsky, Mark J.; Vandermeer, Ben; Shah, Amin; Ow, Mei; Tandon, Puneeta

doi:10.1111/apt.13771

Cited by 54 publications

(60 citation statements)

References 42 publications

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“…The quality of lean tissue, particularly skeletal muscle, is optimally evaluated through functional measures. Several studies have demonstrated that muscle strength deteriorates more quickly than mass, suggesting that it may be a more sensitive measure of “muscle health.” Moreover, in patients with cirrhosis, functional measures (e.g., handgrip, 6‐minute walk, physical frailty, and volume of O 2 peak tests) have been associated with clinical decompensation . These measures are complemented with body composition assessments to better understand the metabolic integrity of the muscle and its ability to perform its tasks.…”

Section: Overview Of the Components Of A Detailed Nutritional Assessmentmentioning

confidence: 99%

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A practical approach to nutritional screening and assessment in cirrhosis

Tandon

Raman

Mourtzakis³

et al. 2017

Hepatology

221

239

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Malnutrition is one of the most common complications of cirrhosis, associated with an increased risk of morbidity and mortality. As a potentially modifiable condition, it is of particular importance to identify malnourished patients so that nutritional therapy can be instituted. Nutrition screening and assessment are infrequently performed in patients with cirrhosis. The reasons for this are multifactorial, including the absence of a validated "rapid" screening tool, multiple definitions of what constitutes malnutrition, and challenges with interpreting body composition and laboratory results in the setting of volume overload and liver dysfunction. This article summarizes the clinically relevant evidence and presents key issues, tools, and clinical options that are applicable to patients with cirrhosis. The definition, etiology, and clinically relevant outcomes associated with malnutrition are reviewed. Rapid nutritional screening is differentiated from more detailed nutritional assessment. Nutritional assessment in special populations, including women and the obese, and the role of inflammation are discussed. Multicenter studies using a common nutritional screening/assessment strategy are the next steps to fast-track adoption and implementation of nutrition-related evaluations into routine clinical practice. (Hepatology 2017;65:1044-1057).

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Section: Overview Of the Components Of A Detailed Nutritional Assessmentmentioning

confidence: 99%

“…and volume of O 2 peak tests) have been associated with clinical decompensation. (41)(42)(43) These measures are complemented with body composition assessments to better understand the metabolic integrity of the muscle and its ability to perform its tasks.…”

Section: Certified Medical Radiologistmentioning

confidence: 99%

A practical approach to nutritional screening and assessment in cirrhosis

Tandon

Raman

Mourtzakis³

et al. 2017

Hepatology

221

239

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“…35 Reduced cardiorespiratory fitness Oxygen uptake during peak aerobic exercise is the gold standard measure of aerobic power (peak VO 2 ) while the distance covered during a 6-min walk test (6MWT) is a measure of aerobic endurance. A reduction in each of these measures correlates with increased mortality [36][37][38][39] and may be a more sensitive predictor of mortality than sarcopenia. 40 In a systematic review of 1,107 cirrhotic patients who underwent liver transplant (LT) evaluation, the mean VO 2peak was 17.4 ml/kg/min, a value falling below the minimum level required for full and independent living (<18 ml/kg/min) and corresponding to the VO 2 expected of a sedentary female in the eighth decade of life.…”

Section: Rationale For Exercise Trainingmentioning

confidence: 99%

Exercise in cirrhosis: Translating evidence and experience to practice

Tandon

Riess

Duarte‐Rojo

et al. 2018

Journal of Hepatology

140

139

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Physical inactivity, sarcopenia, and frailty are highly prevalent, independent predictors of morbidity and mortality in patients with cirrhosis. Across a range of chronic diseases, exercise training is a key recommendation supported by guidelines and, for some conditions, even by governmental funding of exercise programmes. Consistent with the broader chronic disease literature, the evidence for a benefit of exercise in cirrhosis is promising. Several small trials have reported significant improvements in muscle health (mass, strength, functional capacity), quality of life, fatigue, and reductions in the hepatic venous pressure gradient, without adverse events. With strong emerging evidence surrounding the substantial risks of sarcopenia/frailty and our first-hand experiences with liver pre-transplant exercise programmes, we contend that routine patient care in cirrhosis should include an exercise prescription. Some clinicians may lack the resources and necessary background to translate the existing evidence into a practicable intervention. Our team, comprised of physiotherapists, exercise physiologists, hepatologists, transplant specialists, and knowledge translation experts from six North American centres, has distilled the essential background information, tools, and practices into a set of information ready for immediate implementation into clinics ranging from a family practice setting to specialty cirrhosis clinics. Augmenting the rationale and evidence are supplementary materials including video and downloadable materials for both patients and the physician. Supporting the exercising patient is a section regarding information about nutrition, providing practical tips suitable for all patients with cirrhosis.

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“…Moreover, a recent meta‐analysis conducted by Ney et al. demonstrated that the mean difference in pre‐operative VT between post‐operative survivors and nonsurvivors was 2.0 mL/kg/min . In this study, the VT for patients taking beta‐blockers was almost 1.2 mL/kg/min lower compared to those not taking the medication.…”

Section: Discussionmentioning

confidence: 41%

Impact of beta‐blockers on cardiopulmonary exercise testing in patients with advanced liver disease

Wallen

Hall

Dias

et al. 2017

Aliment Pharmacol Ther

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Ventilatory threshold is reduced in patients with advanced liver disease taking beta-blockers compared to those not taking the medication. This may incorrectly risk stratify patients on beta-blockers and has implications for patient management before and after liver transplantation. The oxygen uptake efficiency slope was not influenced by beta-blockers and may therefore be a better measure of cardiopulmonary performance in this patient population.

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Systematic review: pre‐ and post‐operative prognostic value of cardiopulmonary exercise testing in liver transplant candidates

Cited by 54 publications

References 42 publications

A practical approach to nutritional screening and assessment in cirrhosis

A practical approach to nutritional screening and assessment in cirrhosis

Exercise in cirrhosis: Translating evidence and experience to practice

Impact of beta‐blockers on cardiopulmonary exercise testing in patients with advanced liver disease

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