Liver Transplantation · Jul 30, 2026

The impact of supervised aerobic and resistance exercise prehabilitation on frailty and recovery after living donor liver transplantation: Open-label randomized trial

By Gupta S, Mohapatra N, Patil NS et al.

Frailty adversely affects post-transplant outcomes in chronic liver disease (CLD). This study evaluated the feasibility and the impact of preoperative supervised aerobic and resistance exercises (SARE) on frailty and outcomes after living donor liver transplantation (LDLT). This single-center randomized controlled trial assigned recipients of LDLT to standard medical therapy (SMT) or SARE+SMT for 4 weeks pre-LDLT. Liver Frailty Index (LFI), Short Physical Performance Battery (SPPB), pulmonary function tests (PFTs) and postoperative outcomes were compared. Sixty patients [54 (90%) males, 26 (43.33%) alcohol-associated liver disease, 18 (30%) NASH, median MELDNa of 22 (19-27), and CTP A 5 (8.33%), B 22 (36.67%), C 33 (55%)] were randomized (30/group). Baseline parameters, LFI and SPPB were comparable. At enrollment, 46 (76.67%) were prefrail, 7 (11.67%) frail, and 53 (88.33%) were sarcopenic. Seven (11.66%) patients died during workup, 4 were lost to follow-up, and 49 underwent LDLT. In the SARE arm, 40% patients attended ≥5 exercise sessions. No adverse events occurred; recurrent admissions were a hindrance to study adherence. Adjusted analysis showed similar LFI ( p =0.92), SPPB ( p =0.71), and PFT between groups. A borderline improvement in noninvasive ventilation discontinuation ( p =0.05) and earlier chair and bipedal ambulation ( p =0.10 and 0.09, respectively) was observed with SARE. Significant correlations were observed for post operative day 30 (POD30) LFI (mechanical ventilation duration: r =0.56 [ p =0.00], noninvasive ventilation duration: r =0.509 [ p =0.00], hospital stay: r =0.547 [ p =0.00], and intensive care unit [ICU] stay: r =0.563 [ p =0.00]), with similar statistically significant correlations for POD14 and POD30 LFI, SPPB, and PFTs. Preoperative SARE is safe and feasible in patients with high MELD scores and/or CTP C status. LFI, SPPB, PFT, and postoperative outcomes were comparable between groups. SARE showed borderline improvement in ambulation and noninvasive ventilation discontinuation. Better LFI, SPPB, and PFTs predicted improved clinical outcomes.

doi.org/10.1097/lvt.0000000000000972PubMed 42546288Interventions