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

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

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

17 Citations (Scopus)
22 Downloads (Pure)


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 effects, safety and feasibility of prehabilitation in OLT candidates. Relevant articles were searched, in Embase, Web of Science, Cochrane, Medline and Google Scholar, to December 2021. 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. This resulted in 563 potentially eligible studies, out of which eight were selected for inclusion, consisting of 1,094 patients (male sex 68%; mean age 51-61 years; mean MELD score 12-21). Six of the included studies were classified as low-quality by the GRADE system, and three studies had high risk for ineffectiveness of the training program according to the i-CONTENT tool. 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.

Original languageEnglish
Article number10330
Number of pages14
JournalTransplant International
Publication statusPublished - 8 Sept 2022

Bibliographical note

Funding Information:
The authors would like to thank Wichor M. Bramer, PhD, as a biomedical information specialist from the Erasmus University Medical Center medical library for the collaboration in developing and updating the literary search strategy. The authors would also like to thank Sanne E. Hoeks, PhD as a clinical epidemiologist from the Erasmus University Medical Center for assistance with the statistical analyses of the results.

Publisher Copyright:
Copyright © 2022 Jetten, Hogenbirk, Van Meeteren, Cuperus, Klaase and De Jong.


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