List of Titles

Changes in dietary patterns and body composition within 12 months of liver transplantation

- McCoy, Simone, Campbell, Katrina, Lassemillante, Annie-Claude, Wallen, Matthew, Fawcett, Jonathon, Jarrett, Maree, Macdonald, Graeme, Hickman, Ingrid

Authors: McCoy, Simone , Campbell, Katrina , Lassemillante, Annie-Claude , Wallen, Matthew , Fawcett, Jonathon , Jarrett, Maree , Macdonald, Graeme , Hickman, Ingrid
Date: 2016
Type: Text , Journal article
Relation: Hepatobiliary Surgery and Nutrition Vol.6 , no.5 (2017), p. 317-326
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Description: Background: Cardiometabolic risk factors are increasing in liver transplant recipients (LTR). Influencing dietary factors have not been assessed. The aim of this observational study was to assess changes in weight, metabolic function, dietary intake and eating behaviours in the first year after orthotopic liver transplantation (OLT). Methods: Consecutive recruitment of 17 patients (14 males) awaiting OLT at a single tertiary hospital. Dietary intake, food behaviours and anthropometry were recorded at baseline, and 6 and 12 months posttransplant. Results: By 12 months, patients had gained on average 7.3% of body weight. The prevalence of overweight or obesity increased from baseline 53% to 77% (P=0.001). By 6 months, 65% (n=11/17) of patients had altered glucose metabolism. Dietary intake was consistent with a Western-style dietary pattern with high saturated fat. Over half of the patients (69%, n=11/16) reported low to no depressive feelings and rated their self-esteem as good (53%, n=9/16). The Power of Food Scale increased between pre and post-transplant, indicating a stronger appetitive drive. Conclusions: Weight gain occurs early post-transplant, with significant metabolic dysfunction present within 6 months, however is not associated with significant psychological distress. Early dietary intervention designed to limit weight gain and target cardiometabolic health is recommended for this unique patient population.

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Poor cardiorespiratory fitness is a risk factor for sepsis in patients awaiting liver transplantation

- Wallen, Matthew, Woodward, Aidan, Hall, Adrian, Skinner, Tina, Coombes, Jeff, Macdonald, Graeme

Authors: Wallen, Matthew , Woodward, Aidan , Hall, Adrian , Skinner, Tina , Coombes, Jeff , Macdonald, Graeme
Date: 2019
Type: Text , Journal article
Relation: Transplantation Vol. , no. 103(3) (2019), p.529-535
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Description: Background Patients with advanced liver disease are at increased risk of infection and other complications. A significant proportion of patients also have poor fitness and low muscle mass. The primary aim of this study was to investigate if cardiorespiratory fitness and body composition are risk factors for sepsis and other complications of advanced liver disease. Methods Patients being listed for liver transplantation underwent cardiopulmonary exercise testing to determine ventilatory threshold (VT). Computed tomography was used to measure skeletal muscle and subcutaneous and visceral adipose tissue indexes. All unplanned hospital admissions, deaths or delistings prior to transplantation were recorded. Results Eighty-two patients [aged 55.1 (50.6–59.4) years, median (interquartile range); male 87%] achieved a median VT of 11.7 (9.7–13.4) mL[BULLET OPERATOR]kg-1[BULLET OPERATOR]min-1. Their median MELD-Na score was 18 (14–22); and 37 had hepatocellular carcinoma. There were 50 admissions in 31 patients; with 16 admissions for sepsis in 13 patients. Patients with sepsis had a significantly lower VT [sepsis 9.5 (7.8–11.9), no sepsis 11.8 (10.5–13.8) mL[BULLET OPERATOR]kg-1[BULLET OPERATOR]min-1; P=0.003]. No body composition variables correlated with sepsis, nor were there any significant associations between VT and unplanned admissions for other indications. Multivariate logistic regression demonstrated that VT was independently associated with a diagnosis of sepsis (P=0.03). Poisson regression revealed that VT was a significant predictor for the number of septic episodes (P=0.02); independent of age, MELD-Na score, hepatocellular carcinoma diagnosis, presence of ascites, and beta-blocker use. Conclusion Poor cardiorespiratory fitness is an independent risk factor for the development of sepsis in advanced liver disease.

Safety, adherence and efficacy of exercise training in solid-organ transplant candidates: A systematic review

- Wallen, Matthew, Skinner, Tina, Pavey, Toby, Hall, Adrian, Macdonald, Graeme, Coombes, Jeff

Authors: Wallen, Matthew , Skinner, Tina , Pavey, Toby , Hall, Adrian , Macdonald, Graeme , Coombes, Jeff
Date: 2016
Type: Text , Journal article
Relation: Transplantation Reviews Vol. 30, no. 4 (2016), p. 218-226
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Description: Background Patients awaiting solid-organ transplantation may be encouraged to undertake exercise training to improve pre- and post-transplant outcomes. However, the safety, adherence and efficacy of exercise training in this population remain unclear. Methods All randomized, non-randomized and non-controlled trials of exercise training interventions in solid-organ transplant candidates were included. The Cochrane risk of bias tool and a modified Newcastle–Ottawa scale were used to assess procedural quality. Safety was defined as the number of reported adverse events during exercise training. Adherence was evaluated from session attendance, and efficacy as changes in cardiorespiratory fitness (CRF), exercise capacity, muscular strength, health-related quality of life (HR-QoL) and lung function. Results Eleven studies involving 874 patients were included: four randomized controlled, one non-randomized controlled and six non-controlled trials. Six studies included heart transplant candidates and five involved patients awaiting lung transplantation. Three trials included aerobic-only training, one incorporated resistance-only exercise and seven combined modalities. Twelve adverse events were reported with four due to exercise, although methods to collect these data were often omitted. Exercise adherence ranged from 82.5% to 100%, but was poorly described. No significant between-group changes attributable to exercise training were demonstrated. However, significant within-group improvements in CRF, exercise capacity, muscular strength, lung function and HR-QoL were observed. Conclusions Patients awaiting heart or lung transplant appear to tolerate exercise training despite the larger number of adverse events compared to other high-risk populations. Exercise training demonstrated within-group benefits for several outcomes, with no significant between-group differences. Randomized controlled trials with sufficient statistical power are required for all solid-organ transplant candidates. © 2016 Elsevier Inc.

Impact of beta-blockers on cardiopulmonary exercise testingin patients with advanced liver disease

- Wallen, Matthew, Hall, Adrian, Dias, Katrin, Ramos, Joyce, Keating, Shelley, Woodward, Aidan, Skinner, Tina, Macdonald, Graeme, Arena, Ross, Coombes, Jeff

Authors: Wallen, Matthew , Hall, Adrian , Dias, Katrin , Ramos, Joyce , Keating, Shelley , Woodward, Aidan , Skinner, Tina , Macdonald, Graeme , Arena, Ross , Coombes, Jeff
Date: 2017
Type: Text , Journal article
Relation: Alimentary Pharmacology and Therapeutics Vol. , no. (2017), p. 1-7
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Description: Summary Background: Patients with advanced liver disease may develop portal hypertensionthat can result in variceal haemorrhage. Beta-blockers reduce portal pressure andminimise haemorrhage risk. These medications may attenuate measures of car-diopulmonary performance, such as the ventilatory threshold and peak oxygenuptake measured via cardiopulmonary exercise testing. Aim: To determine the effect of beta-blockers on cardiopulmonary exercise testingvariables in patients with advanced liver disease. Methods: This was a cross-sectional analysis of 72 participants who completed acardiopulmonary exercise test before liver transplantation. All participants remainedon their usual beta-blocker dose and timing prior to the test. Variables measuredduring cardiopulmonary exercise testing included the ventilatory threshold, peakoxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and theventilatory equivalents for carbon dioxide slope. Results: Participants taking beta-blockers (n = 28) had a lower ventilatory threshold(P <.01) and peak oxygen uptake (P = .02), compared to participants not takingbeta-blockers. After adjusting for age, the model of end-stage liver-disease score,liver-disease aetiology, presence of refractory ascites and ventilatory thresholdremained significantly lower in the beta-blocker group (P = .04). The oxygen uptakeefficiency slope was not impacted by beta-blocker use. Conclusions: Ventilatory threshold is reduced in patients with advanced liver dis-ease taking beta-blockers compared to those not taking the medication. This mayincorrectly risk stratify patients on beta-blockers and has implications for patientmanagement before and after liver transplantation. The oxygen uptake efficiencyslope was not influenced by beta-blockers and may therefore be a better measureof cardiopulmonary performance in this patient population.

NAFLD in clinical practice : Can simple blood and anthropometric markers be used to detect change in liver fat measured by 1H-MRS?

- Keating, Shelley, Parker, Helen, Hickman, Ingrid, Gomersall, Sjaan, Wallen, Matthew, Coombes, Jeff, Macdonald, Graeme, George, Jacob, Johnson, Nathan

Authors: Keating, Shelley , Parker, Helen , Hickman, Ingrid , Gomersall, Sjaan , Wallen, Matthew , Coombes, Jeff , Macdonald, Graeme , George, Jacob , Johnson, Nathan
Date: 2017
Type: Text , Journal article
Relation: Liver International Vol. 37, no. 12 (2017), p.1907-1915
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Description: Background & Aims: Research in NAFLD management is commonly based on quantitative assessment of liver fat by proton-magnetic resonance spectroscopy (1H-MRS), and translation of this into clinical practice is currently limited by availability and expense. Novel steatosis biomarkers have been proposed for the prediction of liver fatness; however, whether these are suitable for detecting changes in liver fat is unknown. We aimed to determine the accuracy of these indices, and waist circumference (WC), in quantifying longitudinal change in 1H-MRS-quantified liver fat. Methods: We performed a secondary analysis using data from 97 overweight/obese adults (age: 39.7±11.5 years, body mass index: 30.7±4.4 kg/m2, liver fat: 6.0±4.8%, 65% male) who completed either an 8-week exercise or 12-week nutraceutical intervention, with varying degrees of change in liver fat. Baseline and post-intervention measures were liver fat (1H-MRS), NAFLD Liver Fat Score, Liver Fat Equation (LFE), Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), the Visceral Adiposity Index (VAI) and WC. Results: Only the change in HSI, FLI and WC was associated with change in liver fat; however, correlations were weak to moderate. There was no agreement between the LFE and 1H-MRS for detecting liver fat change. Only change in WC significantly affected change in liver fat (P<.001), and WC AUROC for the presence of steatosis was 0.65 and 0.78 for men and women respectively.Conclusions: Novel indices are limited in their ability to detect longitudinal change in liver fat. Waist circumference may offer modest utility as a surrogate to infer liver fat change with lifestyle interventions.
Description: Background & Aims: Research in NAFLD management is commonly based on quantitative assessment of liver fat by proton-magnetic resonance spectroscopy (1H-MRS), and translation of this into clinical practice is currently limited by availability and expense. Novel steatosis biomarkers have been proposed for the prediction of liver fatness; however, whether these are suitable for detecting changes in liver fat is unknown. We aimed to determine the accuracy of these indices, and waist circumference (WC), in quantifying longitudinal change in 1H-MRS-quantified liver fat. Methods: We performed a secondary analysis using data from 97 overweight/obese adults (age: 39.7±11.5 years, body mass index: 30.7±4.4 kg/m2, liver fat: 6.0±4.8%, 65% male) who completed either an 8-week exercise or 12-week nutraceutical intervention, with varying degrees of change in liver fat. Baseline and post-intervention measures were liver fat (1H-MRS), NAFLD Liver Fat Score, Liver Fat Equation (LFE), Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), the Visceral Adiposity Index (VAI) and WC. Results: Only the change in HSI, FLI and WC was associated with change in liver fat; however, correlations were weak to moderate. There was no agreement between the LFE and 1H-MRS for detecting liver fat change. Only change in WC significantly affected change in liver fat (

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