Raffaele Brustia1, Eric Savier2, Olivier Scatton3. 1. Department of hepatobiliary and liver transplantation surgery, hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, France; Université Pierre-et-Marie-Curie, 75005 Paris, France. 2. Department of hepatobiliary and liver transplantation surgery, hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, France. 3. Department of hepatobiliary and liver transplantation surgery, hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, France; Université Pierre-et-Marie-Curie, 75005 Paris, France. Electronic address: olivier.scatton@aphp.fr.
Abstract
BACKGROUND: Early survival after Liver Transplantation (LT) is reduced among sarcopenic patients. Despite, Adapted Physical Activity (APA) before LT is rarely proposed for the risk to impair portal hypertension and its resulting complications. OBJECTIVES: To assess the effects of APA program in adults affected by End Stage Liver Disease (ESLD) on hospital stay, 1-year mortality and morbidity after LT, adverse events (Primary outcomes). Secondary outcomes were changes in VO2 peak, muscle morphology, 6minutes walking distance test (6MWD), Body Mass Index (BMI), MELD, CHILD score and Hepatic Venous Pressure Gradient (HVPG). SEARCH METHODS: MEDLINE, EMBASE, Google Scholar and the Cochrane Library database were explored for randomized clinical trials (RCT). DATA COLLECTION AND ANALYSIS: Data were collected by one review author on the type of study, participants, treatments used for primary and secondary outcomes. Review Manager 5.2 was used for the analysis. MAIN RESULTS: Four RCT with 81 patients were included. Primary outcomes: no severe adverse event was observed, but no published data were available on hospital stay or mortality after LT. SECONDARY OUTCOMES: CHILD, MELD and BMI were not worsened by physical activity. No significant muscle diameter, 6MWD and VO2 peak changes were observed after exercise. Significant reduction in HVPG in the treatment group was observed in a single study (MD-2.5mmHg; 95%CI [-04.76, -0.24]; P=0.03). AUTHORS' CONCLUSIONS: Knowledge in this field is still at an early stage. Evidence derived from small trials of medium quality on ESLD patients suggests that APA is safe, without increasing portal hypertension. Further research is very likely to have an important impact on our confidence in the intervention effect.
BACKGROUND: Early survival after Liver Transplantation (LT) is reduced among sarcopenic patients. Despite, Adapted Physical Activity (APA) before LT is rarely proposed for the risk to impair portal hypertension and its resulting complications. OBJECTIVES: To assess the effects of APA program in adults affected by End Stage Liver Disease (ESLD) on hospital stay, 1-year mortality and morbidity after LT, adverse events (Primary outcomes). Secondary outcomes were changes in VO2 peak, muscle morphology, 6minutes walking distance test (6MWD), Body Mass Index (BMI), MELD, CHILD score and Hepatic Venous Pressure Gradient (HVPG). SEARCH METHODS: MEDLINE, EMBASE, Google Scholar and the Cochrane Library database were explored for randomized clinical trials (RCT). DATA COLLECTION AND ANALYSIS: Data were collected by one review author on the type of study, participants, treatments used for primary and secondary outcomes. Review Manager 5.2 was used for the analysis. MAIN RESULTS: Four RCT with 81 patients were included. Primary outcomes: no severe adverse event was observed, but no published data were available on hospital stay or mortality after LT. SECONDARY OUTCOMES: CHILD, MELD and BMI were not worsened by physical activity. No significant muscle diameter, 6MWD and VO2 peak changes were observed after exercise. Significant reduction in HVPG in the treatment group was observed in a single study (MD-2.5mmHg; 95%CI [-04.76, -0.24]; P=0.03). AUTHORS' CONCLUSIONS: Knowledge in this field is still at an early stage. Evidence derived from small trials of medium quality on ESLD patients suggests that APA is safe, without increasing portal hypertension. Further research is very likely to have an important impact on our confidence in the intervention effect.
Authors: Nikhilesh R Mazumder; Kofi Atiemo; Matthew Kappus; Giuseppe Cullaro; Matthew E Harinstein; Daniela Ladner; Elizabeth Verna; Jennifer Lai; Josh Levitsky Journal: Transplantation Date: 2020-02 Impact factor: 5.385
Authors: Eren Ozcagli; Mehtap Kara; Tugba Kotil; Persefoni Fragkiadaki; Manolis N Tzatzarakis; Christina Tsitsimpikou; Polychronis D Stivaktakis; Dimitrios Tsoukalas; Demetrios A Spandidos; Aristides M Tsatsakis; Buket Alpertunga Journal: Int J Mol Med Date: 2018-04-26 Impact factor: 4.101
Authors: Saro H Armenian; Aleksi Iukuridze; Jennifer Berano Teh; Kristen Mascarenhas; Alex Herrera; Jeannine S McCune; Jasmine M Zain; Sogol Mostoufi-Moab; Shana McCormack; Thomas P Slavin; Jessica M Scott; Lee W Jones; Can-Lan Sun; Stephen J Forman; F Lennie Wong; Ryotaro Nakamura Journal: J Cachexia Sarcopenia Muscle Date: 2020-03-25 Impact factor: 12.910