Prehabilitation for Patients Awaiting Liver Transplantation (Prehab preLT)

Does a Multimodal Prehabilitation Program Improve Markers of Frailty in Patients With Cirrhosis Undergoing Liver Transplantation? A Feasibility Trial

Canadian Donation and Transplantation Research Program, Canadian Association for the Study of the Liver

This study will assess the feasibility, safety and effectiveness of a structured prehabilitation program combining exercise training, nutritional optimization and psychological support for patients with cirrhosis awaiting liver transplantation.

Due to their chronic liver disease, patients with cirrhosis awaiting liver transplantation develop low muscle mass, poor nutritional status and decreased reserves putting them at high risk of postoperative complications, prolonged hospital stay, and failed discharge home after liver transplantation. Prehabilitation aims to optimize a patient before they undergo a major surgery. These programs combine exercise training, with nutritional optimization and psychological support. Together, these contribute to improve their muscle mass, tolerance to exercise, and nutritional status. The current study will assess whether an individualized and structured prehabilitation program combining supervised exercise training, nutritional optimization and psychological support will benefit patients with cirrhosis awaiting liver transplantation.

All participants will be offered a multimodal prehabilitation program. This program will include an individualized and supervised aerobic and resistance exercise training program, nutritional optimization, and psychological support. The program will last 6 months or until liver transplantation, whichever comes first.

Interval change in Royal Free Hospital Global Assessment status, where participants are classified as well nourished, moderately malnourished, or severely malnourished

Interval change in the Chronic Liver Disease Questionnaire (CLDQ) score where lower values indicate worse health-related quality of life.

Inclusion Criteria: Age above 18 years Diagnosis of cirrhosis, based on a combination of clinical, laboratory, imaging, or histology Active on the liver transplant waiting list of the MUHC Exclusion Criteria: Biological Model for End Stage Liver Disease >20 Hepatic decompensation within the last month High risk varices not on primary or secondary prevention Recurrent large volume paracentesis Persistent hepatic encephalopathy Platelets <20,000/µL, or hemoglobin <80g/L Altered hemodynamics Significant heart disease Awaiting combined organ transplantation Awaiting repeat liver transplantation Condition limiting mobilization and/or exercise, or recurrent falls