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Enjeux et intérêts de l’épreuve d’effort cardiorespiratoire en transplantation hépatique

Challenges and opportunities of cardiopulmonary exercise testing in liver transplantation

  • Paramédical / Healthcare Professionals
  • Published:
Réanimation

Résumé

L’épreuve d’effort cardiorespiratoire, utilisée depuis longtemps dans les services de cardiologie et pneumologie, peut apporter des informations intéressantes dans le cadre de la transplantation hépatique. En effet, son caractère dynamique et systémique permet une analyse intégrée des adaptations cardiovasculaires, respiratoires et musculaires à l’exercice ainsi qu’une évaluation du statut fonctionnel du patient. Cet examen permet également de guider de manière objective la mise en place d’un traitement ou d’un programme d’entraînement. À l’heure actuelle, plusieurs études démontrent que le patient cirrhotique a une capacité aérobie altérée et que celle-ci peut être associée à une moins bonne survie post-transplantation. L’American College of Cardiology ne donne pas de recommandations spécifiques pour l’évaluation cardiovasculaire des candidats à la transplantation hépatique. C’est pourquoi, même si l’épreuve d’effort cardiorespiratoire peut apporter des informations intéressantes, tant lors de la mise au point prétransplantation que dans le suivi du patient transplanté, la plupart des centres de transplantation n’utilisent pas cette méthode de manière régulière. Cette revue de la littérature a donc pour objectif de discuter de manière pratique les points importants comme la sécurité, la faisabilité et l’utilité de la technique afin de pouvoir répondre aux interrogations des praticiens sur l’intérêt et les modalités de l’évaluation de la capacité à l’effort en transplantation hépatique.

Abstract

Cardiopulmonary exercise testing (CPET), used for a long time in cardiology and pulmonology, can provide interesting data for liver transplanted patients. Due to its dynamic and systemic nature, CPET allows to integrate the analysis of cardiovascular, respiratory, and muscle changes to exercise as well as to assess patient’s functional status. CPET also offers the opportunity to objectively set up a therapeutic or training program. To date, several studies have shown that the cirrhotic patient’s aerobic capacity is impaired, with a major risk for post-transplantation survival. The American College of Cardiology did not establish specific recommendations for the pre-operative cardiovascular assessment of liver transplant candidates. Therefore, even if CPET can provide useful data both during pre-transplant assessment and transplanted patients’ monitoring, most transplantation centres do not regularly use this method. The purpose of this review is to discuss important practical issues such as safety, feasibility, and usefulness of CPET in order to answer practitioner’s concerns regarding the opportunities and modalities for the evaluation of the capacity to exercise in liver transplantation.

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  1. Service de kinésithérapie, service de gastroentérologie médicochirurgicale, hôpital académique Érasme, Université Libre de Bruxelles, route de Lennik, 808, 1070, Bruxelles, Belgique

    A. Duvivier

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Duvivier, A. Enjeux et intérêts de l’épreuve d’effort cardiorespiratoire en transplantation hépatique. Réanimation 23, 99–108 (2014). https://doi.org/10.1007/s13546-013-0830-4

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