Aerobic capacity in patients with chronic liver disease: Very modest effect of liver transplantation

• Published in: La Presse médicale (1983) 2010-07, Vol.39 (7), p.e174-e181
• Main Authors: Lemyze, Malcolm, Dharancy, Sébastien, Nevière, Remy, Pruvot, François-René, Declerck, Nicole, Wallaert, Benoît
• Format: Article
• Language: English
• Subjects: Adult; Chronic Disease; Exercise Test; Humans; Liver Diseases - physiopathology; Liver Diseases - surgery; Liver Transplantation; Middle Aged
• ISSN: 0755-4982; 2213-0276
• DOI: 10.1016/j.lpm.2009.09.027

Aerobic capacity is commonly impaired in patients with liver cirrhosis, as demonstrated by their low oxygen consumption at peak exercise (peak VO 2). This impairment is correlated with the severity of the liver disease. We investigated the effect of orthotopic liver transplantation (OLT) alone on exercise capacity in this prospective study of patients with liver cirrhosis. Twenty liver transplant candidates, aged 27 to 61 years, underwent resting pulmonary function tests, echocardiography, and incremental cardiopulmonary exercise testing (CPET) before OLT and 16.3 ± 1.6 months after OLT. Following OLT, peak VO 2 increased by a mean of only 7.7% (from 63.4 to 71.1% of predicted value), and decreased in one-quarter of the patients. Cardiac function was normal before OLT and no changes in respiratory indicators followed OLT. Change in peak VO 2 after OLT (Δ peak VO 2) was related to changes in hemoglobin level ( r 2 = 0.45, p = 0.04), the stopping of beta-blocker therapy, and muscle impairment, as suggested by the correlation between Δ peak VO 2 and peak lactate concentration before OLT ( r 2 = 0.64, p < 0.01). Our study provides evidence of a very modest and inconsistent increase in aerobic capacity in liver transplant candidates after liver transplantation alone. This persistent impairment of exercise tolerance was principally of peripheral origin but anemia and beta-blocker treatment should be considered as major aggravating factors. Rehabilitation programs before and after transplantation may increase its benefits to these deconditioned liver transplant recipients in their daily lives. L’aptitude aérobie est classiquement altérée au cours de la cirrhose du foie, comme cela a été montré par l’abaissement de la consommation maximale d’oxygène lors d’un effort maximal (VO 2 pic). Cette altération est corrélée à la sévérité de la maladie hépatique. Le but de ce travail prospectif était d’analyser les effets de la transplantation hépatique (TH) sur la capacité à l’exercice. Vingt patients en attente de TH, âgés de 27 à 61 ans, ont réalisé une exploration fonctionnelle respiratoire de repos et d’exercice (EFX) et une échographie cardiaque avant TH, et exploration fonctionnelle respiratoire de repos et à l’exercice 16,3 ± 1,6 mois après la TH. Après TH, le pic de VO 2 augmentait en moyenne de seulement 7,7 % (de 63,4 à 71,1 % des valeurs prédites) et diminuait chez un quart des patients. La fonction cardiaque évaluée en échographie était normale avant TH. Il n’e