Preoperative pREhabilitation in patients planned for LIVER Transplantation

Patients who qualify for liver transplantation (LT) are mostly frail due to
their underlying liver disease. Frailty is comprised by a decreased functional
capacity, impaired aerobic capacity, and sarcopenia. It is well known that
frailty leads to both increased pre- and post-transplantation morbidity as well
as mortality. For various surgical populations prehabilitation was demonstrated
to be feasible, effective, and to improve surgical outcomes. Few studies on
this subject have been conducted in the patient population awaiting liver
transplantation.

The primary objective is to determine the feasibility of a semi-supervised
homebased prehabilitation program for patients to be waitlisted for LT. The
secondary objectives are to assess the effectiveness of this program and
possible improvements of surgical outcomes (e.g. less complications, faster
recovery, and shorter length of hospital stay).

This is a single-centre, single arm, prospective cohort study.

Patients will participate in an eight-week semi-supervised home based
prehabilitation program. This program consists of physical exercise,
nutritional support provided by a dietician, smoking cessation, and
psychological counselling. The program will be personalized and consists of two
training sessions per week. Through a digital *Oefenportaal* platform the
physical therapist will supervise the exercises and monitor patients* adherence
to the program.

Patients will participate in an eight-week prehabilitation program prior to
anticipated LT. The prehabilitation sessions take approximately 3-5 hours per
week. In order to lower the burden for patients the majority of the program
takes place at home using digital tools. During the first week patients are
seen at the Erasmus MC for an intake (about 60 minutes). All study appointments
will be combined with regular appointments for screening if possible.
Furthermore, patients are expected on-site at the start and after completion of
the prehabilitation program to undergo measurements (90 minutes). Also, they
have to complete questionnaires at home three times total (two times 20
minutes, one time 10 minutes).
Since the prehabilitation program is based on existing care, we expect minimal
risks for the patients. Participants are anticipated to benefit from the
prehabilitation program considering a better physical fitness and a behavioural
change towards a healthier lifestyle.