Prehabilitation and General Management

Liver transplant (LT) offers the only durable hope for cure in patients with end-stage liver disease (ESLD). The LT wait-list time period provides an opportunity to deliver prehabilitation and improve physical fitness, in parallel to optimizing the more established complications, which include encephalopathy, ascites, varices, infection, anemia, diabetes, and renal impairment. Prehabilitation requires a multidisciplinary team approach in order to optimize nutrition, exercise, lifestyle, pharmacotherapy, mental health, and well-being. Exercise is different from physical activity, as it is planned and performed on a repeated basis over an extended period of time for the specific purposes of improving physical fitness, performance, and overall health. The application of exercise training in patients awaiting LT has previously lagged behind other forms of solid organ transplantation. ESLD is not only accompanied by physical frailty and functional dependence, but also emotional, cognitive, and social changes, requiring extensive psychologic adjustments and coping skills.