Background: Postoperative complications have a strong negative impact on clinical outcomes of the liver transplantation (LT). There is evidence indicating that aerobic capacity is associated with better postoperative prognosis. Prehabilitation, defined as the process of enhancing the functional capacity, appears as highly promising preventive intervention in candidates for LT who characteristically exhibit poor cardiorespiratory reserve and exercise capacity.
Goal of Study: To evaluate the feasibility and safety of a personalized physical training program to improve aerobic capacity in LT candidates.
Materials and Methods: Prospective pilot quasi-experimental study. Candidates for LT were invited to participate in a 6-8 week outpatient fitness program (personalized and elapsed in the community setting). Main outcome measures:
i) training-induced enhancement of aerobic capacity (endurance time [ET]), mesured with a cardiopulmonary exercise test; and,
ii) health-related quality of life, mesured with different quality of life and physical activity questionnaires (time frame: before and after the exercise training program). Data were compared to those from contemporaneous matched LT candidates that follow standard care. Comparisons were done using chi2 test for categorical variables and Student's test for numerical variables.
Results: 27 patients (58±7 yr-old, 78% male): 14 (preHAB-group) and 13 (control group) were included. The baseline demographic and clinical characteristics of the patients, including indications and degree of hepatic dysfunction (Child score) were similar in both groups, except for MELD that was superior in the preHAB-group. In preHAB-group only 6 patients completed the program. In control group 8 patients completed the initial and final evaluation. PreHAB-group showed an increase in aerobic capacity (ET from 263±51 to 816±355 sec, p=0.016), physical activity index (YALE from 40±10 to 75±14, p< 0.01) and quality of life (CLDQ from 3.7±0.8 to 4.3±1.0 p=0.025) and a clear trend to diminish anxiety and depression symptoms (HAD from 14±11 to 12±11, p=0.084) after the program. Control group remained unchanged after the same period.
Conclusion(s): A personalized physical training program is feasible, safety and may help to improve aerobic capacity, physical activity and quality of life and probably diminish anxiety and depression symptoms in LT candidates. Its impact on postoperative outcome needs to be evaluated in a randomized trial.

Feasibility and effectiveness of a personalised physical training program (prehabilitation) for the improvement of aerobic capacity in liver transplant candidates as a pre-surgical optimization maneuver: a pilot study