Browsing by Subject "liver transplant"

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Computed tomography measures of nutrition in patients with end-stage liver disease provide a novel approach to characterize deficits
    (Elsevier, 2018) Bush, Weston J.; Davis, Jason P.; Maluccio, Mary A.; Kubal, Chandrashekhar A.; Salisbury, Jared B.; Mangus, Richard S.; Surgery, School of Medicine
    Aim Patients with cirrhosis and end-stage liver disease (ESLD) develop severe nutrition deficits that impact on morbidity and mortality. Laboratory measures of nutrition fail to fully assess clinical deficits in muscle mass and fat stores. This study employs computed tomography imaging to assess muscle mass and subcutaneous and visceral fat stores in patients with ESLD. Methods This 1:1 case-control study design compares ESLD patients with healthy controls. Study patients were selected from a database of ESLD patients using a stratified method to assure a representative sample based on age, body mass index (BMI), gender, and model for end-stage liver disease score (MELD). Control patients were trauma patients with a low injury severity score (<10) who had a CT scan during evaluation. Cases and controls were matched for age +/- 5 years, gender, and BMI +/- 2. Results There were 90 subjects and 90 controls. ESLD patients had lower albumin levels (p<0.001), but similar total protein levels (p=0.72). ESLD patients had a deficit in muscle mass (-19%, p<0.001) and visceral fat (-13%, p<0.001), but similar subcutaneous fat (-1%, p=0.35). ESLD patients at highest risk for sarcopenia included those over age 60, BMI< 25.0, and female gender. We found degree of sarcopenia to be independent of MELD score. Conclusions These results support previous research demonstrating substantial nutrition deficits in ESLD patients that are not adequately measured by laboratory testing. Patients with ESLD have significant deficits of muscle and visceral fat stores, but a similar amount of subcutaneous fat.
  • Thumbnail Image
    Item
    Fatigue as Reported at 12 Time Points during the First Year Post-Liver Transplant
    (2013) Scott, Patricia J.; Krause, Audrey; Tector, A. Joseph; Kwo, Paul
    BACKGROUND: Although liver transplantation has evolved as an effective procedure, fatigue remains a post-transplant complaint [1]. As yet, there are no published accounts of the experience of fatigue at temporal intervals during the first post-transplant year, and this information would benefit LT candidates in recovery planning. Van Ginneken [2] found that time since transplant was not associated with physical fatigue and reduced activity, but was associated with albumin levels less than 25g/l and with lower GFR. METHODS: Data used in this study were collected through an ongoing, longitudinal, prospective design. Results presented here are for fatigue and biometric data at 12 data points starting one week post hospital discharge, continued weekly for the first 8 weeks, then monthly at 3, 6, 9, and 12 months. RESULTS: We sampled 30 subjects: 19 (70.4%) male and 8 (29.6%) female, age 55.4 ± 9.8 years. A mixed models analysis of variance was done to investigate a change in FACIT over time. The initial model included age, MELD, sex, week, albumin, ALT, BILI T, and CREAT. The final model included age, BILI T, and week. Increasing age and BILI T were associated with greater fatigue (p=0.0376 and p=0.0005, respectively). There was significant decrease in fatigue over time (p<0.0001). Pair-wise comparisons were done to determine which weeks significantly differed. Tukey’s adjustment for multiple comparisons was used. Figure 1 indicates which visits significantly differed. DISCUSSION: Our subjects experienced decreased fatigue over time. The data set was rich with prospectively collected longitudinal information helpful for establishing realistic expectations for post-transplant fatigue. Finding include early weeks of recovery (weeks 2-3) differ from weeks 7+ and that there is no significant change after 3 months, up to one year. No association was seen with Albumin levels although total bilirubin and age were associated with greater fatigue.
  • Thumbnail Image
    Item
    Influencing functional outcomes: a look at role performance and satisfaction with life following liver transplant
    (2008-09) Scott, Patricia J.; Misra, Vijay Laxmi; Mangus, Richard S.; Tector, A. Joseph; Lacerda, Marco A.; Vinayek, Rakesh; Munsch, Linda; Musick, Beverly; Kwo, Paul
    Abstract 572 The success of orthotopic liver transplantation (OLT), originally measured as survival, now extends to quality of the life saved. Return to work (RTW) is also a desired outcome. Our AIM was to explore the relationship between 5 pre-OLT factors & 5 post-OLT quality of life (QOL) domains with life satisfaction and primary productive role to better understand how to improve both. METHODS: Patients (pts)1-3 yrs post-OLT filled QOL form during follow-up clinic visits between 7/04 to 6/05. The Liver transplantation Database-Quality of life (LTD-QOL) form yielded data on 5 domains: measure of disease (MOD), psychological distress/well-being (PDW), personal function (PF), social/role function (SRF) & general health perception (GHP). Results: 229 pts were first categorized as satisfied overall with life (79%), or dissatisfied, and then assigned to groups based on primary productive role (51%), no primary productive role, or retired. Pre-OLT variables were age, gender, marital status, education, & etiology of liver disease; HCV (33%), alcohol liver disease (ALD)(11%), HCV+ALD (10%), & others (46%). Marital status & age were not significantly related to the outcome variables. Etiology of liver disease, education, and time since OLT and 5 post-OLT QOL domains were significantly associated with both outcome variables; satisfaction and primary productive role (p<.0001).To understand the differences, the 5 physical & men-tal QOL domains were regressed on primary productive role and satisfaction. Pts (mean age 54 yrs (19-74 yrs), males, 70%) fell into the category of primary productive role rates (51%). Pts transplanted for ALD were significantly (p<.05) more likely to be satisfied with life, whereas individuals with HCV±ALD, had lowest satisfaction and were most likely to be unable/uninterested in work. Stepwise logistical regression analysis of satisfaction demonstrated that GHP and SRF correlated most highly. Although satisfaction was significant in bivariate analysis, regression analysis of the influence of domains of QOL, as well as employment, demonstrated that SRF & GHP correlated most highly with life satisfaction. CONCLUSIONS: SRF and GHP correlate with good QOL post OLT. HCV patients have low levels of satisfaction whereas the highest level of satisfaction is in the ALD group. Further studies should address methods to improve satisfaction in those with HCV.
  • Thumbnail Image
    Item
    Post-extubation Dysphagia in Liver Transplant Patients
    (2020-09-12) Atoa, S.; Kubal, C.A.; Ekser, B.; Spears, M.; Wrightson, T.; Mangus, M.J.; Mangus, R.S.
  • Thumbnail Image
    Item
    Quality Improvement in Liver Transplant Anesthesia: Early Extubation in the Operating Room
    (2021-09-18) Rao, S H; Villamayor, A; Ariyo, P; Frank, S; Latif, A; Rizkalla, N; Merritt, W T; Gurakar, A; Pustavoitau, A
  • Thumbnail Image
    Item
    Supporting Healthy Lifestyles of Liver Transplant Candidates and Recipients
    (Office of the Vice Chancellor for Research, 2014-04-11) Halle, Jessie; LeMond, Katelyn; Robinson, Irene; Sloss, Rebecca
    Background: Currently, liver transplant (LTx) recipients do not receive occupational therapy services post discharge. Literature addresses post-LTx issues, many within the scope of occupational therapy practice including physical quality of life (sleep, pain, mobility, sexual functioning, nutrition, physical fatigue and physical activity), physiological quality of life (anxiety and depression, self-image, coping style, fear of graft rejection, noncompliance, and physiological fatigue), and role return. Therefore, implementing an occupational therapy intervention addressing common post-LTx issues could facilitate return to valued roles and occupations. Purpose: The purpose of this study is to examine the feasibility of an educational and supportive intervention to assist LTx recipients in return to valued roles and daily activities. Method: Evaluation of a program based on translation of data from a longitudinal recovery study. The basis of evaluation was a patient satisfaction survey from session content and environment. The goal was to assess feasibility of our occupational therapist led post-LTx intervention program. Results: Based on survey results from the Spring-Fall 2013 education sessions, 100% of responses would recommend the sessions for others, and the average numerical response for “how helpful did you find the manual” was 3.44 (Likert scale 1-4 with 4 being very helpful). When asked what would you improve, responses ranged from "being more structured" to "increasing the number of participants”. Results following program modification showed 100% of participants would recommended the session for others, and 100% found the location and time of sessions convenient. The average response for “how helpful did you find the manual” was 3.38, with 54% of participants finding the manual very helpful. Implications for Practice: This research contributes evidence for the content of an educational intervention post -LTx. Our research identified benefits of the program and improvements to maximize participant satisfaction. This study highlights the need for occupational therapy interventions and patient education post-LTx.
  • Thumbnail Image
    Item
    What Is Hot and New in Basic Science in Liver Transplantation in 2018? Report of the Basic Science Committee of the International Liver Transplantation Society
    (Wolters Kluwer, 2019-04) Martins, Paulo N.; Selzner, Markus; Dayangac, Murat; Ling, Qi; Ng, Kevin T.; Huang, Kuang-Tzu; Taner, Timucin; Mas, Valeria R.; Ekser, Burcin; Surgery, School of Medicine