Functional capacity before and after liver transplantation.

The maximal oxygen uptake (VO(2) max) is a standard tool for preoperative counseling of candidates for lung and heart transplantations, as well as an optional measurement to assess liver or renal transplant patients. Also, it provides an objective tool of the functional capacity of posttransplant patients. Exercise limitation and loss of aerobic capacity are common among patients with end-stage liver disease. The functional capacity of these subjects is decreased, as estimated by measuring the VO(2) max in a cardiopulmonary exercise test (CPET). After transplantation improvement is expected in physical capacity. We sought to describe the influence of orthotopic liver transplantation (OLT) on the physical fitness of the recipient at 3 and 12 months after transplantation. Since CPET is an objective test, it is an important tool for clinicians to evaluate patients' functional capacity before and after OLT.

Management and outcome of liver recipients with post-transplant lymphoproliferative disease.

BACKGROUND/AIMS: The possibility of development of post-transplant lymphoproliferative disease by patients receiving immunosuppressive therapy is well known. However, elective treatment and outcome remain controversial. We reviewed the management and outcome of our patients with post-transplant lymphoproliferative disease. METHODOLOGY: Records of 457 patients who underwent orthotopic liver transplantation from 1986 to 1997 were analyzed. Patients who developed post-transplant lymphoproliferative disease were reviewed retrospectively. Incidence, clinical presentation, risk factors and outcomes were examined with special emphasis on ductopenic rejection and hilum involvement. RESULTS: Eleven patients developed a post-transplant lymphoproliferative disease (2.4%). These were B-cell non-Hodgkins lymphoma, Epstein-Barr virus-associated in all cases. Five patients (45.5%) received monoclonal antibodies or antithymocyte globulin. Seven patients (63.6%) developed a lymphoproliferative disease before 9 months post-transplant and 4 recipients (36.4%) after 20 months. No late lymphomas regressed after withdrawal from immunosuppression. Six patients (54.5%) were treated with chemotherapy. Eight patients (72.7%) had a tumoral remission. Five patients (45.5%) developed chronic rejection after immunosuppressant discontinuation. Four of them died as a consequence of ductopenic rejection and retransplantation was required in another; 2 died due to graft hilum infiltration. Five patients (45.5%) are alive after a follow-up of 36.5 +/- 32 months (range: 4-77 months). CONCLUSIONS: Patients with post-transplant lymphoproliferative disease require a close follow-up in order to promptly treat conditions that could lead to death. In our series, these were more closely associated with a failing transplanted organ than with the lymphoma itself.