Avaliação da capacidade funcional de pacientes com 30 dias após transplante hepático

Abstract

Context: Liver transplantation (TxH) is the current standard therapy for patients with acute or chronic irreversible hepatic impairment. The evaluation of functional capacity is of fundamental importance in these patients, since they present important limitations for the return of activities of daily living. Objective: To evaluate the functional capacity of patients in the postoperative period of liver transplantation. METHODS: A cross-sectional study conducted at the Walter Cantídio University Hospital (HUWC) and at the Laboratory of Cardiorespiratory Physiotherapy and Exercise Physiology of the Federal University of Ceará from June 2017 to June 2018, the sample consisted of patients who were 30 days old of TxH, totaling 100 patients. Patients aged 18 to 70 years who did not present hepatic encephalopathy, difficulties in locomotion or orthopedic limitations were included in the study. Patients were submitted to a postoperative evaluation consisting of clinical evaluation, physical examination and complementary exams (spirometry, inspiratory muscular force (MIP) and expiratory (MEP) by manovacuometry and 6-minute walk test (6MWT)]. The following measurement instruments were used: Fatigue severity scale (FSS); Hospital scale of anxiety and depression; London Chest activity of daily living (LCADL) and Duke acativity status index (DASI). The work was approved by the HUWC ethics and research committee. Results: Among the 100 patients studied, 69% were males, mean age was 55.5 years and higher prevalence for viral hepatitis (52%) as a cause for liver transplantation. Presence of comorbidities was found in 39% of transplant patients and 40 patients had respiratory symptoms. The mean body mass index was 25.0. After the TxH 19% of the patients presented anxiety symptoms, 11% depressive symptoms and in relation to fatigue 29% reported the symptom. The functional capacity, evaluated by DASI, obtained an average of 15.5; LCADL 13.5; maximal mean oxygen consumption of 16.2 and metabolic component METs 4.6 evidencing a trend towards functional impairment of the patients. Regarding the mean lung function for FEV1 of 2.3 L and FV of 3.2 L, and in relation to the predicted values are within normal, FEV1 87.6% and FVC 86.6%. In inspiratory and expiratory muscle strength values of -70.0 and 79.5, respectively, predicted to be 74.5% for Pimáx and 79.1% for Pemáx, slightly lower than expected. The value of the 6MWT was 349.9 meters, with a predicted value of 61%, being below normal. No correlations were found for spirometry, manovacuometry and 6MWT with DASI, VO2 and METS measurements. The functional capacity measures evaluated by the DASI scale, METS and VO2 calculation showed a significant correlation with LCADL (respectively r = -0.2, p = 0.04 and r = -0.1 p = 0.05 and r = -0 , P = 0.04), dyspnea measurement (respectively r = -0.2, p = 0.03 and r = -0.2 p = 0.03 and r = -0.2, p = 0.03 ) and with age (respectively r = -0.2, p = 0.03 and r = -0.2 p = 0.02 and r = -0.2, p = 0.03) showing that a limitation in functional capacity is associated with a compromise of activities of daily living. It was also observed that the same measures correlated with dyspnea and age. Conclusion: This study may be a useful tool for transplantation centers that allows an objective evaluation of functional measures of exercise capacity such as the metabolic component and maximal oxygen consumption, thus seeking perspectives for new intervention measures for physical rehabilitation programs.