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[Evaluation of the nutritional status and physical performance in candidates to liver transplantation]
Ana V A Leitão1, Carmen L N Castro, Tatianna M Basile
1Laboratório de Pesquisa em Capacidade Física, Função Muscular e Avaliação Nutricional, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, RJ.
Insights
Pre-transplant liver patients often have significant physical impairments and malnutrition, regardless of liver disease severity. These findings highlight the need for comprehensive pre-operative assessments in orthotopic liver transplantation (OLT) candidates.
Area of Science:
- Hepatology
- Transplantation Medicine
- Geriatrics
Context:
- Orthotopic liver transplantation (OLT) is a life-saving procedure for end-stage liver disease.
- Pre-transplant physical capacity and nutritional status are crucial determinants of post-operative outcomes.
- The Child-Pugh classification is a standard measure of liver dysfunction severity.
Purpose:
- To assess the physical function and nutritional status of patients awaiting OLT.
- To determine the correlation between physical capacity, nutritional status, and liver function severity (Child-Pugh classification).
Summary:
- A study of 32 pre-OLT patients revealed high prevalence of physical impairments (72.5% low performance, 32% quadriceps weakness) and malnutrition (62.5%).
- Impaired balance, coordination, and gait velocity were common findings.
- Nutritional status and physical performance metrics, including the 6-minute walk test and Karnofsky index, showed no significant association with Child-Pugh scores.
Impact:
- Physical impairments and nutritional deficits are highly prevalent in OLT candidates, irrespective of liver disease severity.
- These findings underscore the importance of evaluating physical capacity and nutritional status beyond traditional liver function tests.
- Comprehensive pre-transplant assessments are vital for optimizing patient selection and post-operative care in OLT.
Objective:
To evaluate the physical capacity and nutritional status of patients before orthotopic liver transplantation (OLT) and to correlate these parameters to the severity of liver function.
Methods:
Thirty-two patients before OTL were classified as Child-Pugh A (25%), B (22%) and C (53%). Physical capacity was analyzed by the quadriceps and ankle strength, balance, coordination, gait velocity, 6 minute walk test, get up and go test, Barthel and Karnofsky indexes. Nutritional status was evaluated by using Mendenhall score and Blackburn classification.
Results:
Quadriceps weakness was found in 32% of the patients. Impaired balance and coordination were detected in 34.8% and 15.6% of the patients. Low physical performance was found in 72.5% of the patients (6 min walk test: 31.6% severely; 40.9% moderately impaired) and 43.8% required considerable assistance when the Karnofsky index was applied. Malnutrition was found in 62.5% of the patients (34.37% moderately and severely malnourished and 28.13% mildly malnourished). Chi-square analysis showed no association between Child-Pugh classification and nutritional status, the 6 min walk test and Karnofsky index. The association between the two functional tests was statistically significant (p<0.001).
Conclusion:
The results show that physical impairment and nutritional deficit were highly prevalent in the patients studied, independent of the degree of hepatic dysfunction evaluated by the traditional Child-Pugh classification.
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