Comorbidities and Coexisting Conditions, Liver Transplantation
Conditions
Brief summary
Background: Liver transplantation is the only curative treatment for patients with end-stage liver disease. Short-term survival has improved due to improved surgical techniques and greater efficacy of immunosuppressive drugs. At present, the 10-year survival after liver transplantation is 60%, but long-term survival has not improved to the same extent the short-term survival. In addition to liver- and transplant-related causes, comorbidities such as cardiovascular, pulmonary, renal, and metabolic diseases have emerged as leading causes of morbidity and mortality in liver transplant recipients. The objective of this study is to assess the burden of comorbidities and identify both liver- and transplant-related risk factors as well as traditional risk factors that contribute to the pathogenesis of comorbidity in liver transplant recipients. Methods/design: The DACOLT study is an observational, longitudinal study. The investigators aim to include all adult liver transplant recipients in Denmark. Participants will be matched by sex and age to controls from the Copenhagen General Population Study (CGPS) and the Copenhagen City Heart Study (CCHS). Physical and biological measures including blood pressure, ancle-brachial index, spirometry, exhaled nitric oxide, electrocardiogram, transthoracic echocardiography, computed tomography (CT) angiography of the heart, unenhanced CT of chest and abdomen and blood samples will be collected using uniform protocols in participants in CGPS, CCHS and DACOLT. Blood samples will be collected and stored in a research biobank. Follow-up examinations at regular intervals up to 10 years of follow-up are planned. Discussion: There is no international consensus standard for optimal clinical care or monitoring of liver transplant recipients. The study will determine prevalence, incidence and risk factors for comorbidity in liver transplant recipients and may be used to provide evidence for guidelines on screening and long-term treatment and thereby contribute to improvement of the long-term survival.
Interventions
None listed
Sponsors
Rigshospitalet, Denmark
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
* Liver transplanted * age between 20 and 100 years * be able to understand the study information in either Danish or English and to be able to provide an informed consent
Exclusion criteria
* none
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of coronary artery disease | Baseline cross-sectional data | Assessed by coronary CT angiography |
| Change in Coronary artery disease | 10 years follow-up | Assessed by coronary CT angiography |
| Cardiac function | Baseline cross-sectional data | Determined by transthoracic echocardiography |
| Change in Cardiac function | 10 years follow-up | Determined by transthoracic echocardiography |
| Cardiac structure | Baseline cross-sectional data | Determined by transthoracic echocardiography |
| Change in cardiac structure | 10 years follow-up | Determined by transthoracic echocardiography |
| Change in Cardiac structure | 10 years follow-up | Assessed by cardiac computed tomography (CT) |
| Dynamic lung function indices assessed by spirometry | Baseline cross-sectional data | FVC and FEV1 assessed by spirometry |
| Change in Dynamic lung function indices assessed by spirometry | 10 years follow-up | FVC and FEV1 assessed by spirometry |
| Renal function | Baseline cross-sectional data | Estimated glomerular filtration rate |
| Change in Renal function | 10 years follow-up | Estimated glomerular filtration rate |
| Metabolic diseases | Baseline cross-sectional data | Prevalence of Diabetes |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of Depression | Baseline cross sectional data | Major Depression Inventory (MDI): A depression questionnaire. The questionnaire consists of the ten symptoms contained in the World Health Organization WHO's depression demarcation. The patient's completed questionnaire is scored using a scoring key. When MDI is used as a rating scale in the same way as the Hamilton scales, then the sum of the ten questions indicates the degree of depression. The theoretical score range is from 0 (no depression) to 50 (maximum depression). Mild depression: MDI total score from 21 to 25 Moderate depression: MDI total score from 26 to 30 Severe depression: MDI total score of 31 or higher |
| Change in Depression | 10 years follow-up | Major Depression Inventory (MDI): A depression questionnaire. The questionnaire consists of the ten symptoms contained in the World Health Organization WHO's depression demarcation. The patient's completed questionnaire is scored using a scoring key. When MDI is used as a rating scale in the same way as the Hamilton scales, then the sum of the ten questions indicates the degree of depression. The theoretical score range is from 0 (no depression) to 50 (maximum depression). Mild depression: MDI total score from 21 to 25 Moderate depression: MDI total score from 26 to 30 Severe depression: MDI total score of 31 or higher |
| Fracture risk | Baseline cross sectional data | FRAX® score. The FRAX® tool has been developed to evaluate fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors. The FRAX® algorithms give the 10-year probability of fracture. The output is a 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). |
| Change in Fracture risk | 10 year follow-up | FRAX® score. The FRAX® tool has been developed to evaluate fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors. The FRAX® algorithms give the 10-year probability of fracture. The output is a 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). |
| Obstructive pulmonary disease | Baseline cross sectional data | Nitric oxide in exhaled breath |
| Prevalence of Peripheral artery disease | Baseline cross sectional data | Ankle-brachial-index (ABI) is measured using a Doppler meter by determining the systolic pressure in the arm and ankle. |
| Change in Peripheral artery disease | 10 years follow-up | Ankle-brachial-index (ABI) is measured using a Doppler meter by determining the systolic pressure in the arm and ankle. |
Countries
Denmark
Contacts
PRINCIPAL_INVESTIGATORSusanne D Rasmussen, Professor, MD, DMSc
Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet
STUDY_DIRECTORAllan Rasmussen, MD
Department of Transplantation and Digestive Diseases, Copenhagen University Hospital - Rigshospitalet
STUDY_DIRECTORKlaus F Kofoed, Professor, MD, PhD, DMSc
Department of Cardiology, Copenhagen University Hospital - Rigshospitalet
STUDY_DIRECTORTor Biering-Sørensen, Professor, MD, MSc, PhD
Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte
Outcome results
None listed