生体肝移植患者の退院時運動耐容能に影響する周術期因子を明らかにする

抄録

【Objective】 Living-donor liver transplantation (LDLT) recipients frequently present with preoperative conditions such as malnutrition, edema, muscle atrophy, and hepatic encephalopathy. These factors, combined with a high incidence of postoperative complications, often hinder the recovery of physical endurance. This study aimed to identify perioperative factors associated with exercise tolerance at hospital discharge in LDLT recipients.

【Design】 observational study.

【Methods】 We analyzed adult LDLT cases from January 2021 to December 2023. Patients with severe complications or missing 6MWD data were excluded. Preoperative, intraoperative, and postoperative factors were collected, including demographics, lab values, muscle metrics, and mobility indicators. Exercise tolerance was assessed via 6-minute walk distance (6MWD) before surgery and at discharge. Statistical analysis used univariate and multivariate regression to identify factors associated with discharge 6MWD (significance: p<0.05).

【Result】 Discharge 6MWD was significantly associated with age, sex, BMI, preoperative MELD score, preoperative grip strength, preoperative 6MWD, ICU length of stay, and days to independent walking after surgery (all p<0.05). Multiple regression analysis identified preoperative 6MWD (β＝0.52, p＝.0001) and age (β＝−0.23, p＝.021) as independent predictors of exercise tolerance at discharge (R²＝0.56).

【Conclusion】 Preoperative 6MWD was the strongest predictor of exercise tolerance at hospital discharge. These findings suggest that early rehabilitation interventions before LDLT may play a critical role in enhancing postoperative physical recovery.