AUTHOR=Jetten Wesley D. , Hogenbirk Rianne N. M. , Van Meeteren Nico L. U. , Cuperus Frans J. C. , Klaase Joost M. , De Jong Renate 

TITLE=Physical Effects, Safety and Feasibility of Prehabilitation in Patients Awaiting Orthotopic Liver Transplantation, a Systematic Review

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10330

DOI=10.3389/ti.2022.10330

ISSN=1432-2277

ABSTRACT=Prehabilitation improves surgical outcomes in patients undergoing surgery. However, patients preparing for orthotopic liver transplantation (OLT) are physically ‘frail’ and suffer from comorbidities that generally hamper physical activity. This systematic review aims to evaluate the physical effect, safety and feasibility of prehabilitation in OLT candidates. 
Embase, Web of Science, Cochrane, Medline and Google Scholar were searched to December 2021, for relevant articles. Studies reporting on specified preoperative exercise programs, including adult OLT candidates with end-stage liver disease, with a model for end-stage liver disease (MELD) score ≥12 or Child-Pugh classification B/C, were included. 
Eight out of 563 potentially eligible studies were selected consisting of 1084 patients (male sex 68%; mean age 51-61 years; mean MELD score 12-21). Significant improvement was observed in VO2 peak, 6-minute walking distance hand grip strength, liver frailty index and quality of life. Feasibility ranged from an adherence of 38–90% in unsupervised- to >94% in supervised programs. No serious adverse events were reported. 
In conclusion, prehabilitation in patients awaiting OLT appears to improve aerobic capacity, and seems feasible and safe. However, larger clinical trials are required to accurately examine the preoperative and postoperative effects of prehabilitation in this specific patient population.