RESUMO
BACKGROUND: Patients with liver cirrhosis experience a hyperdynamic circulation. OBJECTIVE: To investigate the association between early hemodynamic changes and graft function after liver transplant. METHODS: Those patients who underwent liver transplantation in 2016 were enrolled in the study. Liver function indices measured in postoperative days (POD) 1, 3, 5, 7, 9, and 11 along with hemodynamic indices including pulse rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and central venous pressure (CVP) measured q6h in the first 3 days after transplantation were recorded. RESULTS: 57 deceased-donor liver recipients with a mean±SD age of 41.4±11.8 years including 33 (58%) males were enrolled in the study. The mean±SD aspartate and alanine aminotransferases, alkaline phosphatase, and lactate dehydrogenase were significantly decreased from 1879±670.5, 369.2±40.5, 174.9±18.8, and 1907.6±323.1 U/L in POD 1 to 37.2±10.7, 243.4±37.3, 207.5±19.5, and 382.4±59.8 U/L in POD 3, respectively (p=0.028, <0.001, 0.002, and 0.001, respectively). During this period, the pulse rate of the patients was significantly (p<0.001) decreased by a median (IQR) of 28.7 (8.5-39.7) beats/min; it was significantly correlated with a decrease in serum hepatic enzymes activities during this period. SBP, DBP, and CVP were significantly increased (p<0.001 for all) during this period. Liver graft function improved significantly earlier in those patients with a mean pulse rate of 87 beats/min compared with others (p=0.03). CONCLUSIONS: There may be an association between changes of hemodynamic indices, especially reduction of pulse rate, and improved graft function early after liver transplantation.
RESUMO
BACKGROUND: Non-adherence to medical care programs in transplant recipients is considered one of the life-threatening factors in transplant recipients, which can prevent achieving the desired levels of health care. OBJECTIVE: To determine perceptions of liver transplant recipients about the barriers to their adherence to medical care programs. METHODS: This study was conducted based on a qualitative content analysis method using semi-structured interviews with 23 liver transplant recipients, their families, and the transplant teams. A purposive sampling method was used in liver transplant clinics affiliated to Tehran University of Medical Sciences, Tehran, Iran, from May to November 2017. RESULTS: Three main categories including factors related to therapeutic problems (educational problems and medication challenges), personal factors (self-management disability), as well as social problems (cultural conditions and passive family) were identified as the barriers to adherence to medical care programs. CONCLUSION: Paying attention to barriers to adherence to medical care and planning for moderating them in a collaborative effort between transplant recipients and health care providers could increase the likelihood of survival and quality of life in these patients.