Effect of herbal medicine daikenchuto on oral and enteral caloric intake after liver transplantation: A multicenter, randomized controlled trial.

OBJECTIVE: Postoperative early oral or enteral intake is a crucial element of the Enhanced Recovery After Surgery (ERAS) protocol. However, normal food intake or enteral feeding cannot be started early in the presence of coexisting bowel dysfunction in patients undergoing liver transplantation (LT). The aim of this multicenter, randomized, double-blinded, placebo-controlled trial was to determine the enhancement effects of the Japanese herbal medicine Daikenchuto (DKT) on oral/enteral caloric intake in patients undergoing LT. METHODS: A total of 112 adult patients undergoing LT at 14 Japanese centers were enrolled. The patients were randomly assigned to receive either DKT or placebo from postoperative day (POD) 1 to 14. The primary endpoints were total oral/enteral caloric intake, abdominal distension, and pain on POD 7. The secondary endpoints included sequential changes in total oral/enteral caloric intake after LT, and portal venous flow volume and velocity in the graft. RESULTS: A total of 104 patients (DKT, n = 55; placebo, n = 49) were included in the analyses. There were no significant differences between the two groups in terms of primary endpoints. However, postoperative total oral/enteral caloric intake was significantly accelerated in the DKT group compared with the placebo group (P = 0.023). Moreover, portal venous flow volume (POD 10, 14) and velocity (POD 14) were significantly higher in the DKT group than in the placebo group (P = 0.047, P = 0.025, P = 0.014, respectively). CONCLUSIONS: Postoperative administration of DKT may enhance total oral/enteral caloric intake and portal venous flow volume and velocity after LT and favorably contribute to the performance of the ERAS protocol.

A vitamin D protocol post-liver transplantation.

BACKGROUND AND PURPOSE: Adults with compromised liver function are inherently deficient and especially vulnerable to the consequences of vitamin D deficiency. Consequences of vitamin D deficiency include liver disease progression, infection, and graft failure. A vitamin D supplementation protocol is proposed to systematically optimize serum vitamin D levels according to guidelines in both pre- and post-liver transplanted patients. METHODS: This quasiexperimental study included a sample of N = 45 post-liver transplanted patients taking daily cholecalciferol (vitamin D3) 2500 units for 12 weeks, with a pre- and post-lab measure of serum 25-hydroxyvitamin D levels at a large academic facility. CONCLUSIONS: Seventy-eight percent of patients reached minimum guideline levels using the protocol with an average increase of serum vitamin D of 13.8 ng/mL. Long-term outcomes of clinical significance may include decreased incidence of acute T-cell-mediated graft rejection and infections in the immunocompromised patient. IMPLICATIONS FOR PRACTICE: Optimizing vitamin D in vulnerable patient populations such as chronic liver disease and the immunosuppressed posttransplanted patient has the potential to curtail complications of vitamin D deficiency. As a result, nurse practitioners employing a vitamin D protocol can create a favorable impact on patient quality of life, safety, and healthcare spending.

The role of narrative medicine in pregnancy after liver transplantation.

UNLABELLED: Narrative medicine allows professionals from all fields of medical sciences to understand the patient's total experience of illness, and meet his/her needs in an empathetic environment. Narrative medicine helps spread holistic knowledge of a multitude of complex clinical conditions, including transplantation. OBJECTIVE: To underline the role of narrative medicine in women who become pregnant after a liver transplant by using their narrations of this very special experience. METHODS: We describe our study with narration and listening to the stories of three women expecting their first child after a liver transplant, by analysing the structure and role of narration in the context of relationships between patients and caregivers. The narrations were transcribed verbatim with the main plot analysed in order to address all the aspects of this rare clinical condition and the transition to parenthood. RESULTS: The women narrated this experience in three phases: transplantation, pregnancy and delivery, and post-partum. They described all phases of pregnancy as stressful but satisfying, whereas the fact of becoming a mother was perceived as a victory both as a woman and as a transplant patient. CONCLUSIONS: Our results suggest that narrative medicine represents a significant professional tool for caring for transplant patients during pregnancy.

[The early rehabilitation of the patients following extensive liver resection and transplantation].

This study included 500 patients who had undergone extensive liver resection and transplantation of whom 250 were treated with the use of remedial gymnastics, physiotherapeutic factors, and massage. The positive dynamics of objective characteristics of the patients' condition. None of the treated patients showed a negative response to the proposed program of medical rehabilitation and activation throughout the early postoperative period.

Active music engagement with emotional-approach coping to improve well-being in liver and kidney transplant recipients.

Liver and kidney transplant recipients report elevated psychological distress following transplant in comparison to other types of organ transplant recipients. Negative affective states can lead to immune dysregulation and adverse health behaviors, and therefore may contribute to disease. In contrast, positive affective states can broaden individuals' thoughts and actions to promote the accumulation of coping resources. Coping strategies have traditionally been conceived of as being either problem-focused or emotion-focused in nature, while contemporary theory and research supports a different division: approach-oriented strategies versus avoidance-oriented strategies. Emotional expression and processing may function as an approach-oriented coping strategy. Emotional-approach coping relates to the use of emotional expression, awareness and understanding to facilitate coping with significant life stressors. The current study evaluated the impact of music therapy with and without a specific emphasis on emotional-approach coping. This randomized, controlled trial aimed to use Active Music Engagement with Emotional-Approach Coping to improve well-being in post-operative liver and kidney transplant recipients (N = 29). Results indicated that music therapy using Emotional-Approach Coping led to significant increases in positive affect, music therapy using Active Music Engagement led to significant decreases in pain, and both conditions led to significant decreases in negative affect, an indicator of perceived stress/anxiety.

Effect of emodin in suppressing acute rejection following liver allograft transplantation in rats.

OBJECTIVE: To investigate the mechanism of action of emodin for suppressing acute allograft rejection in a rat model of liver transplantation. METHODS: Brown Norway (BW) recipient rats of orthotopic liver transplantation (OLT) were divided into three groups, Group A receiving isografting (with BW rats as donor), Group B receiving allografting (with Lewis rats as donor), Group C receiving allografting and emodin treatment (50 mg/kg daily). They were sacrificed on day 7 of post-transplantation, and their hepatic histology, plasma cytokine levels, and T-cell subset expression were detected. RESULTS: Compared with those in Group A, rats: in Group B exhibited severe allograft rejection with a rejection activity index (RAI) of 7.67+/-0.98, extensive hepatocellular apoptosis with an apoptosis index (AI) of 35.83+/-2.32, and elevated plasma levels of interleukin-2 (IL-2), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha), CD4(+) and CD4 CD4(+)/CD8(+) ratio. However, recipients in Group C showed a decrease in histological grade of rejection and hepatocellular apoptosis, as well as a decrease in plasma levels of IL-2, TNF-alpha, CD4(+) and CD4(+)/CD8(+) ratio, but elevated levels of IL-10 as compared with the allograft group. CONCLUSION: Post-OLT acute rejection could be attenuated by emodin, its mechanism of action may be associated with protecting hepatocytes from apoptosis, polarizing the Th 1 paradigm to Th2, and inhibiting the proliferation of CD4(+) T cell in plasma.

Liver transplant recipients' first year of posttransplant recovery: a longitudinal study.

A longitudinal study of 20 liver transplant recipients was conducted to investigate their posttransplant recovery experience. Data were collected using semistructured interviews at 6 weeks, 6 months, and 1 year after transplantation. Qualitative analysis of data revealed physical, psychological, social, economic, and spiritual dimensions of recovery. Findings reflect ongoing improvement of physical health and functionality for most recipients. Those with continuing health problems often suffered from preexisting health conditions. Psychological adjustment was uneven, with intermittent periods of fear, anxiety, and depression. Some recipients reported short-lived split identities and personality changes. Social support of family was critical in the hospital and at home. Economic issues became primary by the 1-year interview, with all recipients questioning whether they could afford ongoing healthcare and medicines. Spiritual needs were met in secular and nonsecular activities. Findings suggest that healthcare personnel should attend to the lived experience of liver transplant recipients.

[Nutritional therapy in liver transplantation]. / Terapia nutricional no transplante hepático.

BACKGROUND: Malnutrition, sometimes severe is common in patients with chronic hepatic diseases who are candidates for liver transplantation. Nutritional therapy can induce partial or total correction of such deficiencies, improving clinical conditions and prognosis of patients who face the great defiance of liver transplantation. AIMS: Brief revision of hepatic role in the metabolism of several nutrients. Description of available methods of dietary therapy and its application both under different abnormal hepatic conditions and pre and post-transplant periods. The role of nutritional intervention in metabolic side effects due to immunosuppressive drugs. CONCLUSION: Nutritional therapy is a valuable adjuvant resource to the clinical treatment of candidates and submitted patients to hepatic transplantation providing better prognosis and improved life quality.

Relationship of hardiness and sense of coherence to post-liver transplant return to work.

The article reports a retrospective survey designed to determine the relationship of hardiness and sense of coherence to post-liver transplant return to work (RTW). Instruments used included Pollock's Health-Related Hardiness Scale and Antonovsky's Sense of Coherence Questionnaire. Study results were based on 230 adult liver transplant recipients responding to a mailed questionnaire. After transplantation, 63% of the participants were working. Participants with higher levels of hardiness and higher sense of coherence scores demonstrated higher RTW rates. Using logistic regression, a model comprising hardiness and sense of coherence correctly classified 90% of the participants who returned to work.