The obesity epidemic in the United States continues to grow. Estimates are that currently 70 percent of the U.S. population is either overweight or obese. In 2013, the American Medical Association recognized obesity as a disease defined as chronic, relapsing, multifactorial and neurobehavioral where an increase in body fat promotes tissue dysfunction and abnormal physical stress to the body because of fat mass.
A patient undergoing any major surgery, including laparoscopic donor nephrectomy, experiences a temporary decline in their functional capacity. The goal of an enhanced recovery after surgery (ERAS) program is to return a patient to baseline functional status as soon as possible without sacrificing safety, quality, comfort or long-term outcomes.
The impact of frailty on outcomes for liver transplant recipients is gaining widespread attention in transplant programs around the world. In numerous studies, frailty has been associated with increased length of stay, increased hospitalizations, increased costs, and increased mortality. Frailty has even been shown to have as much of an impact on patient survival as a high MELD (Model for End Stage Liver Disease).
It all started with one very sick patient. Transplant cardiologists Shelley Hall, MD, and Robert Gottlieb, MD, PhD, and cardiothoracic surgeon Gonzo Gonzalez-Stawinski, MD, with Baylor University Medical Center, part of Baylor Scott & White Health, faced a difficult situation. A heart transplant was needed for a patient with biventricular heart failure and multiple comorbidities, but her condition made her a poor candidate for bridging mechanical support therapy, like a ventricular assist device (VAD). Even though the Heart Transplant Program in the Baylor Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Center is nationally recognized for short donor organ wait times, it was not clear if a suitable donor heart would appear before the patient succumbed to the disease.
