Keiichiro Shindo, MD, PhD, Ken Sugiyama, MD, PhD, Kazunori Nishijima, MD, Yoshihito
Furusawa, MD, PhD, Takeo Kondo, MD, PhD, Shin-Ichi Izumi, MD, PhD
Jpn J Compr Rehabil Sci 4: 67-72, 2013
Reports of critical illness polyneuropathy (CIP) following liver transplantation (LT) are rare, and rehabilitative approaches for CIP after LT have yet to be described in detail. Four patients who underwent living-donor LT developed extremity and/or respiratory muscle weakness after LT, suggesting of CIP. Rehabilitation was initiated at the bedside to prevent joint contracture, disuse muscle weakness, and pulmonary complications. Exercise intensity was increased gradually according to a set of safety indices. Electrophysiologic studies demonstrated motor-dominant axonal degenerations in extremities of all patients. Although no patient recovered fully by rehabilitation, all patients achieved gradual improvement in muscle strength, ability to walk with or without aid, and a final Barthel index score of 90. CIP is an important complication following LT, and should be suspected in patients who develop post-transplant muscle weakness in the extremities or respiratory muscles. The present results suggest that early rehabilitation after LT prevents secondary disuse syndrome and contributes to achieve favorable functional outcome.
Key words: living-donor liver transplantation, rehabilitation, critical illness polyneuropathy, functional outcome, exercise load