Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct;36(10):e14686.
doi: 10.1111/ctr.14686.

The role of prehabilitation on short-term outcomes after liver transplantation: A review of the literature and expert panel recommendations

Carmen Vinaixa  1   2 , Graciela Martínez Palli  3   4 , Donald Milliken  5 , Daniel Sellers  6 , Sebastien Dharancy  7 , Michael Spiro  8   9 , Dimitri Aristotle Raptis  10   9 , Didier Samuel  11 ; ERAS4OLT.org Working Group
Collaborators, Affiliations

The role of prehabilitation on short-term outcomes after liver transplantation: A review of the literature and expert panel recommendations

Carmen Vinaixa et al. Clin Transplant. 2022 Oct.

Abstract

Background: Prehabilitation programs as part of ERAS protocols are being increasingly used in multiple surgeries, improving postoperative outcomes. Data regarding prehabilitation programs in patients awaiting liver transplantation and their outcomes is scarce.

Objectives: To identify whether prehabilitation programs based on exercise training conducted prior to liver transplantation improve short-term postoperative outcomes, and to provide expert panel recommendations.

Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.

Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Studies included those evaluating postoperative outcomes, as well as those evaluating functional outcomes.

Prospero id: CRD42021236305.

Results: Of the 170 studies screened, only one assessed the primary objective. Most studies focus on the preoperative impact of exercise training on aerobic capacity, muscle mass and/or strength, showing positive effects and no significant adverse events, but are underpowered and with heterogenous designs and interventions. The non-randomized observational study which assessed relevant postoperative outcomes, showed a non-significant trend towards reduced 90-day readmission rate and shorter length of stay in the prehabilitation group.

Conclusions: Prehabilitation prior to liver transplantation is unlikely to be harmful, and likely to have short term benefits on functional status. We cautiously recommend prehabilitation on the basis of absence of harm and possibility of benefit (Quality of Evidence; Very Low | Grade of Recommendation; Low).

Keywords: exercise; liver transplantation; physical therapy; physiotherapy; prehabilitation.

PubMed Disclaimer

References

REFERENCES

    1. Montano-Loza AJ, Meza-Junco J, Prado CMM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10(2):166-173.
    1. Montano-Loza AJ, Meza-Junco J, Baracos VE, Prado CMM. Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation. Liver Transpl. 2014;20(6):9.
    1. Lee CS, Cron DC, Terjimanian MN, et al. Dorsal muscle group area and surgical outcomes in liver transplantation. Clin Transplant. 2014;28(10):1092-1098.
    1. Tandon P, Ney M, Irwin I, et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value: impact of severe muscle depletion on wait-list mortality. Liver Transpl. 2012;18(10):1209-1216.
    1. Lai JC, Feng S, Terrault NA, Lizaola B, Hayssen H, Covinsky K. Frailty predicts waitlist mortality in liver transplant candidates: frailty in liver transplant candidates. Am J Transplant. 2014;14(8):1870-1879.

Publication types

LinkOut - more resources