Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Effects of an active lifestyle on the physical frailty of liver transplant candidates
Ilias Marios Oikonomou, Emmanouil Sinakos, Nikolaos Antoniadis, Ioannis Goulis, Olga Giouleme, Maria Anifanti, Georgios Katsanos, Konstantina-Eleni Karakasi, Georgios Tsoulfas, Evangelia Kouidi
Ilias Marios Oikonomou, Nikolaos Antoniadis, Georgios Katsanos, Konstantina-Eleni Karakasi, Georgios Tsoulfas, Department of Transplant Surgery, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Emmanouil Sinakos, Ioannis Goulis, The Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Olga Giouleme, The Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Maria Anifanti, Evangelia Kouidi, Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
Author contributions: Oikonomou IM and Kouidi E designed the research study; Oikonomou IM, Sinakos E, Antoniadis N, Goulis I, Giouleme O, Anifanti M, Katsanos G, and Tsoulfas G performed the research; Oikonomou IM and Karakasi KE analyzed the data and results; Oikonomou IM wrote the manuscript; and all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Aristotle University of Thessaloniki Institutional Review Board (Approval No. 65/2021).
Informed consent statement: All patients participating in the study provided written and informed consent prior to their inclusion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: There are no additional data available.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of things.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ilias Marios Oikonomou, MD, MPhil, Surgeon, Department of Transplant Surgery, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, Thessaloniki 54642, Greece. i.m.oikonomou@gmail.com
Received: June 15, 2022
Peer-review started: June 15, 2022
First decision: August 4, 2022
Revised: August 26, 2022
Accepted: October 18, 2022
Article in press: October 18, 2022
Published online: November 18, 2022
BACKGROUND
Liver transplantation is the most important therapeutic intervention for end-stage liver disease (ELD). The prioritization of these patients is based on the model for end-stage liver disease (MELD), which can successfully predict short-term mortality. However, despite its great validity and value, it cannot fully incorporate several comorbidities of liver disease, such as sarcopenia and physical frailty, variables that can sufficiently influence the survival of such patients. Subsequently, there is growing interest in the importance of physical frailty in regard to mortality in liver transplant candidates and recipients, as well as its role in improving their survival rates.
AIM
To evaluate the effects of an active lifestyle on physical frailty on liver transplant candidates.
METHODS
An observational study was performed within the facilities of the Department of Transplant Surgery of Aristotle University of Thessaloniki. Twenty liver transplant candidate patients from the waiting list of the department were included in the study. Patients that were bedridden, had recent cardiovascular incidents, or had required inpatient treatment for more than 5 d in the last 6 mo were excluded from the study. The following variables were evaluated: Activity level via the International Physical Activity Questionnaire (IPAQ); functional capacity via the 6-min walking test (6MWT) and cardiopulmonary exercise testing; and physical frailty via the Liver Frailty Index (LFI).
RESULTS
According to their responses in the IPAQ, patients were divided into the following two groups based on their activity level: Active group (A, 10 patients); and sedentary group (S, 10 patients). Comparing mean values of the recorded variables showed the following results: MELD (A: 12.05 ± 5.63 vs S: 13.99 ± 3.60; P > 0.05); peak oxygen uptake (A: 29.78 ± 6.07 mL/kg/min vs S: 18.11 ± 3.39 mL/kg/min; P < 0.001); anaerobic threshold (A: 16.71 ± 2.17 mL/kg/min vs S: 13.96 ± 1.45 mL/kg/min; P < 0.01); 6MWT (A: 458.2 ± 57.5 m vs S: 324.7 ± 55.8 m; P < 0.001); and LFI (A: 3.75 ± 0.31 vs S: 4.42 ± 0.32; P < 0.001).
CONCLUSION
An active lifestyle can be associated with better musculoskeletal and functional capacity, while simultaneously preventing the evolution of physical frailty in liver transplant candidates. This effect appears to be independent of the liver disease severity.
Core Tip: This study highlights the importance of regular physical activity and exercise of low and medium intensities in the routine of liver transplant candidates. As liver transplantation is a highly demanding procedure, imposing a significant amount of stress across every system, physical frailty is steadily proving to be a factor of great importance, not only due to its role in mortality prediction but also due to its potential improvement via preoperative interventions.
