Transplant

Welcome to the Mayo Clinic Transplant page! Mayo Clinic is the largest integrated transplant provider in the United States, performing over 2,000 solid organ and bone marrow transplants each year at our campuses in Arizona, Florida and Minnesota.

In these pages, there are materials for transplant recipients as well as living donors. No matter where you are in your transplant journey, our goal is to connect you to others and provide you with information and support.

PUBLIC PAGE
Tue, Apr 25, 2017 8:50am

Frailty: What is it and how can it Affect Patients with Cirrhosis?

By Kymberly D. Watt, M.D., @kymberlywatt

Rahima A. Bhanji, M.D. was a special contributor to this blog post. Dr. Bhanji is a gastroenterology research fellow at Mayo Clinic in Rochester, Minnesota. Her interests include frailty, sarcopenia, end-stage liver disease needing liver transplantation and post-transplant care.

For someone needing a liver transplant, waiting can take a toll on strength and physical function. The progression of liver disease contributes to patients being less active. In addition, patients with progression of disease may have no appetite which may lead to poor nutrition. These changes can make you frail. If you become frail, can that physical weakness determine how well you do after liver transplant?

That is the question doctors at the Harvard Medical School were trying to answer when they conducted a study to determine how frailty affected outcomes for people with liver failure, a condition in which scar tissue builds up on the liver and causes the liver to not function properly. Because this damage to the liver can’t be fixed, people with liver failure usually require a transplant.image-c348501f1f23

Let’s take a look at the study, the findings, and what this means for you.

About the study

This study, by Elliot B. Tapper and colleagues from Harvard Medical School was published in Hepatology in May 2015. It evaluates how frail a patient is and whether it impacts how they do after transplant. In this study, frailty was measured by using assessment tools that looked at the ability to complete activities of daily living, risk of developing bed sores, and likelihood of falling.

This research focused on 734 patients who were in the hospital with liver failure between 2010 and 2013. Researchers looked at how frail a patient was as a predictor of how well they did in terms of survival, readmission to hospital, and needing rehabilitation or physical therapy after the hospital stay.

The findings

Researchers found that frail patients were more likely to have complications and a longer hospital stay. They were two times more likely to die in the next three months and nearly four times more likely to need physical therapy after the hospital stay. 

Why it matters

It appears that simple bedside assessments of a patient’s strength and physical function can help predict complications for people with liver failure.

This knowledge matters because it alerts your care providers that you need an appropriate intervention. Studies have shown changes in diet and exercise can reverse frailty. Further research is being performed in patients with liver cirrhosis to assess the impact of diet and exercise on frailty.

If you are being treated for liver failure, talk to your care team about what you can do to maintain a level of strength that will ensure optimal long-term results, especially if transplant may be among your treatment options. Patients who remain active and have a good nutritional status have a better recovery after their transplant.

If you’ve had a liver transplant, what did you do to keep healthy before your surgery?

HELPFUL LINKS

 

I used to walk with a group of girlfriends, but eventually that became a great burden. When I needed to be hospitalized, my transplant team brought physical therapist to my bedside, with the goal to get me mobile and moving. Upon release, I used a walker for stability and a wheelchair for bigger distances. Eventually, I got rid of walker before transplant and continued to walk slowly as preparation before my transplant..
After my transplant, my walking strength improved as I was able to increase my routine.
Rosemary

I was overweight and I knew that my recuperation would be better if I lost weight and was in better shape. I was already going to a health club for pool exercises but I stepped that up and did more on my recumbent bike, and got my weight down to a healthier weight. My BMI was still slightly in the overweight range, down from being in the obese range. I have read though that as you get older a little extra weight can be helpful if you get sick so I don't worry about that — of course the operative word there is "little".

I never had a problem with mobility prior to transplant and I recovered amazingly quickly after transplant. Even my transplant team was impressed. My PCP commented, about 6 weeks prior to transplant, just before things started going downhill, that if he didn't know I was sick, he would think I was perfectly healthy! I had very little physical therapy after transplant.

Let's face it, the motivation of a better recovery is a pretty big one. I am very happy that I did what I did and trying hard to keep the weight off.
JK

@contentandwell

I was overweight and I knew that my recuperation would be better if I lost weight and was in better shape. I was already going to a health club for pool exercises but I stepped that up and did more on my recumbent bike, and got my weight down to a healthier weight. My BMI was still slightly in the overweight range, down from being in the obese range. I have read though that as you get older a little extra weight can be helpful if you get sick so I don't worry about that — of course the operative word there is "little".

I never had a problem with mobility prior to transplant and I recovered amazingly quickly after transplant. Even my transplant team was impressed. My PCP commented, about 6 weeks prior to transplant, just before things started going downhill, that if he didn't know I was sick, he would think I was perfectly healthy! I had very little physical therapy after transplant.

Let's face it, the motivation of a better recovery is a pretty big one. I am very happy that I did what I did and trying hard to keep the weight off.
JK

Jump to this post

@contentsndwell
I have time before I'll be on the hot list so I am using it to get in the best shape ever. Now..we all know that it is much more difficult to achieve success with our complications….but it is worth it to know it will make life much easier on the other side…and that you gave it your all!
Anyone who wants to share diet and exercise ideas..please do…be creative.

@jeanne5009 I have mentioned this many times before on this forum so those who have been with it for a while might say "there she goes again", but I don't know how I would have done it without tracking everything I put in my mouth by using myfitnesspal.com. Initially it is somewhat cumbersome but then it gets easier. I also used a fitness tracker to make sure I really was getting enough exercise.
Without those two things I know I would not have been successful. The one other thing I did was to make an excel sheet and track my weight daily. My scale shows an estimate of your BMI and fluid too so I kept track of all of that. It was reassuring if my weight went up to see that I was retaining fluid, plus it let me know that I must have overdone sodium.
Good luck to you. I firmly believe that my excellent recovery had a lot to do with what I did beforehand.
JK

Please login or register to post a reply.

Invite Others

Send an email to invite people you know to join the Transplant page.

We'll include this text in the user's invitation.