Challenges and opportunities of cardiopulmonary exercise testing in liver transplantation

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.