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Aerobic capacity during cardiopulmonary exercise testing and survival with and without liver transplantation for patients with chronic liver disease
Author(s) -
Bernal William,
MartinMateos Rosa,
Lipcsey Miklós,
Tallis Caroline,
Woodsford Kyne,
Mcphail Mark J.,
Willars Christopher,
Auzinger Georg,
Sizer Elizabeth,
Heneghan Michael,
Cottam Simon,
Heaton Nigel,
Wendon Julia
Publication year - 2014
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23766
Subject(s) - medicine , liver transplantation , anaerobic exercise , vo2 max , chronic liver disease , aerobic capacity , liver disease , transplantation , anthropometry , multivariate analysis , cardiology , gastroenterology , aerobic exercise , oxygen pulse , surgery , heart rate , physical therapy , cirrhosis , blood pressure
Chronic liver disease (CLD) is associated with muscle wasting, reduced exercise tolerance and aerobic capacity (AC). Measures of AC determined with cardiopulmonary exercise testing (CPET) may predict survival after liver transplantation (LT), but the relationship with nontransplant outcomes is uncertain. In patients assessed for LT, we examined the relationship of CPET AC parameters with the severity of liver disease, nutritional state, and survival with and without LT. Patients assessed for elective first LT who underwent CPET and an anthropometric assessment at a single center were studied. CPET‐derived measures of AC that were evaluated included the peak oxygen consumption (VO 2 peak) and the anaerobic threshold (AT). Three hundred ninety‐nine patients underwent CPET, and 223 underwent LT; 45% of the patients had a VO 2 peak < 50% of the predicted value, and 31% had an AT < 9 mL/kg/minute. The VO 2 peak and AT values correlated with the Model for End‐Stage Liver Disease score, but they more closely correlated with serum sodium and albumin levels. The handgrip strength correlated strongly with the VO 2 peak. Patients with impaired AC had prolonged hospitalization after LT, and nonsurvivors had lower AT values than survivors 1 year after transplantation ( P < 0.05); this was significant in a multivariate analysis. One hundred seventy‐six patients did not undergo LT; the 1‐year mortality rate was 34.6%. The AT ( P < 0.05) and VO 2 peak values ( P < 0.001) were lower for nonsurvivors. In a multivariate analysis, AT was independently associated with nonsurvival. In conclusion, AC was markedly impaired in many patients with CLD. In patients who did not undergo transplantation, impaired AT was predictive of mortality, and in patients undergoing LT, it was related to postoperative hospitalization and survival. AC should be evaluated as a modifiable factor for improving patient survival whether or not LT is anticipated. Liver Transpl 20:54–62, 2014 . © 2013 AASLD.