A carregar...
Publicação
Impact of pre-transplant frailty and sarcopenia on the post-transplant prognosis of cirrhotic patients
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 634.62 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
A fragilidade constitui um estado de reserva fisiológica reduzida com impacto multissistémico, tornando os doentes mais suscetíveis a eventos adversos e morbi-mortalidade. A sarcopénia, frequentemente associada à fragilidade, constitui a redução patológica da massa muscular. Tanto a fragilidade como a sarcopénia associam-se a aumento da mortalidade em doentes cirróticos em lista de espera para transplante hepático. Conduzimos uma revisão sistemática focada no impacto da fragilidade e sarcopénia pre-transplante no prognóstico pós-transplante em doentes adultos com cirrose hepática.
Foi feita uma pesquisa de referências online em três bases de dados: Medline, Embase e Cochrane Central. Das 12 276 referências recuperadas inicialmente, 30 integraram a revisão qualitativa.
Globalmente, a fragilidade e a sarcopénia apresentaram, consistentemente, um impacto negativo nos resultados pós-transplante, estando associadas a redução da sobrevivência. Estas diferenças são variáveis nos estudos, com aumento de 50% e 2 vezes na mortalidade a 10 e 5 anos nas formas graves, respetivamente. Adicionalmente, estes doentes requerem mais tempo de internamento, incluindo em unidade de cuidados intensivos, e têm maior frequência de complicações como sépsis e complicações respiratórias. A reversibilidade da fragilidade depende do grau de incapacidade física pré-transplante e das comorbilidades que potenciam este síndrome.
A fragilidade e sarcopénia constituem assim uma faca de dois gumes: os doentes que as apresentam deveriam ser priorizados para transplante pois apresentam maior mortalidade em lista de espera; Por outro lado, fragilidade e sarcopénia acentuadas podem justificar remoção da lista de espera tendo em conta o prognóstico desencorajador pós-transplante. Uma melhor compreensão deste problema é crucial para tornar mais eficaz o processo de alocação de transplantes hepáticos.
Frailty constitutes a state of reduced physiologic reserve with multisystemic impact, turning patients more susceptible to adverse events and morbi-mortality. Sarcopenia usually associates with frailty and constitutes a pathological reduction of muscle mass. Frailty and sarcopenia increase mortality in patients with liver cirrhosis on liver transplant waitlist. We conducted a systematic review focused on the impact of frailty and sarcopenia pre-transplant on post-transplant outcomes in adult patients with liver cirrhosis. We performed a search for references in three online platforms: Medline, Embase and Cochrane Central. Of the 12 276 references initially recovered, 30 integrated the qualitative review. Overall, frailty and sarcopenia consistently presented a negative impact on post-transplant outcomes, associating with reduced early and late post-transplant survival. These differences were variable across different studies, with an overall up to two-fold and 50% increase at 5- and 10-year mortality, respectively for severe conditions. Moreover, these patients required longer ICU and hospitalization time, and had higher rates of complications such as sepsis and respiratory complications. The reversibility of frailty depended on the severity of functional impairment pre-liver transplantation and on the co-morbidities contributing to frailty. Taken all this into consideration, frailty and sarcopenia are double-edge swords: patients with frailty/sarcopenia should be prioritized for liver transplantation since they will die sooner on waitlist; however, severe frailty/sarcopenia may justify delisting, since it associates with dismal prognosis post-liver transplantation. Better understanding of this conundrum is crucial for a more efficient transplant allocation process.
Frailty constitutes a state of reduced physiologic reserve with multisystemic impact, turning patients more susceptible to adverse events and morbi-mortality. Sarcopenia usually associates with frailty and constitutes a pathological reduction of muscle mass. Frailty and sarcopenia increase mortality in patients with liver cirrhosis on liver transplant waitlist. We conducted a systematic review focused on the impact of frailty and sarcopenia pre-transplant on post-transplant outcomes in adult patients with liver cirrhosis. We performed a search for references in three online platforms: Medline, Embase and Cochrane Central. Of the 12 276 references initially recovered, 30 integrated the qualitative review. Overall, frailty and sarcopenia consistently presented a negative impact on post-transplant outcomes, associating with reduced early and late post-transplant survival. These differences were variable across different studies, with an overall up to two-fold and 50% increase at 5- and 10-year mortality, respectively for severe conditions. Moreover, these patients required longer ICU and hospitalization time, and had higher rates of complications such as sepsis and respiratory complications. The reversibility of frailty depended on the severity of functional impairment pre-liver transplantation and on the co-morbidities contributing to frailty. Taken all this into consideration, frailty and sarcopenia are double-edge swords: patients with frailty/sarcopenia should be prioritized for liver transplantation since they will die sooner on waitlist; however, severe frailty/sarcopenia may justify delisting, since it associates with dismal prognosis post-liver transplantation. Better understanding of this conundrum is crucial for a more efficient transplant allocation process.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Fragilidade Sarcopénia Cirrose hepática Transplante hepático Transplantação