Systematic review: pre‐ and post‐operative prognostic value of cardiopulmonary exercise testing in liver transplant candidates

Ney,  M.; Haykowsky, M. J.; Vandermeer, B.; Shah, A.; Ow, M.; Tandon, P..
Alimentary Pharmacology & Therapeutics, October 2016, Vol. 44 Issue:
Number 8 p796-806, 11p;

Abstract: Cardiopulmonary exercise testing
(CPET) is the gold standard for the objective assessment of functional
status. In many conditions, CPET outperforms the traditional variables
in predicting mortality. In patients with cirrhosis listed for liver
transplantation, our primary aim was to determine the prognostic value
of CPET for pre‐and post‐transplant mortality and, in particular,
whether CPET remained predictive after adjustment for liver disease
severity. A systematic literature review was conducted in databases
Medline, Scopus, Embase and PubMed. Where possible, data were pooled
for meta‐analyses using a DerSimonian and Laird random effects model. A
total of seven studies were retrieved, including 1107 patients with a
mean MELD of 14.2 (standard deviation 1.6) and peak baseline VO2of 17.4
mL/kg/min. In all of the studies in which multivariable analysis was
performed, CPET variables were independent predictors of pre‐transplant
mortality (three studies) and post‐transplant mortality (four studies).
In the three studies where we could aggregate post‐transplant mortality
data, post‐transplant mortality was predicted by AT with a mean
difference of 2.0 (95% confidence interval, CI: 0.42–3.59; Z= 2.48, P=
0.01) between survivors and nonsurvivors. The peak VO2was not
significant (0.77 95% CI: −1.36 to 2.90; Z= 0.71, P= 0.48). Patient’s
listed for liver transplant have significant functional limitations,
with a weighted mean VO2 below the threshold level required for
independent living. Although heterogeneity in study designs with
respect to timing, CPET variables, and cut‐off values precluded the
determination of CPET mortality thresholds, the studies support CPET as
an objective and independent predictor of pre‐ and post‐transplant