PREHABILITATION IN PATIENTS AWAITING LIVER TRANSPLANTATION – A REVIEW OF CURRENT EVIDENCE

Tomasz Mruzek; Artur Marcysiak; Patrycja Mularczyk; Karolina Zawadzka; Magdalena Kiełbasiewicz; Wojciech Łysoniewski; Małgorzata Sikorska; Nina Polek; Julia Strumińska

doi:10.31435/ijitss.3(51).2026.5722

Authors

Tomasz Mruzek UCK WUM Central Clinical Hospital, ul. Banacha 1a, 02-097 Warsaw, Poland https://orcid.org/0009-0002-3800-0172
Artur Marcysiak Mazovian Voivodeship Hospital of St. John Paul II in Siedlce, ul. Poniatowskiego 26, 08-110 Siedlce, Poland https://orcid.org/0009-0002-8801-3836
Patrycja Mularczyk Nowy Dwór Medical Center, ul. Miodowa 2, 05-100 Nowy Dwór Mazowiecki, Poland https://orcid.org/0009-0000-1733-7185
Karolina Zawadzka Nowy Dwór Medical Center, ul. Miodowa 2, 05-100 Nowy Dwór Mazowiecki, Poland https://orcid.org/0009-0005-8304-4993
Magdalena Kiełbasiewicz Nowy Dwór Medical Center, ul. Miodowa 2, 05-100 Nowy Dwór Mazowiecki, Poland https://orcid.org/0009-0003-7055-0518
Wojciech Łysoniewski F. Ceynowa Specialist Hospital in Wejherowo, ul. dr. A. Jagalskiego 10, 84–200 Wejherowo, Poland https://orcid.org/0009-0006-4850-6379
Małgorzata Sikorska Nowy Dwór Medical Center, ul. Miodowa 2, 05-100 Nowy Dwór Mazowiecki, Poland https://orcid.org/0009-0006-3768-7338
Nina Polek Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Poland https://orcid.org/0009-0000-3233-5866
Julia Strumińska Independent Public Voivodeship Complex Hospital in Szczecin, Arkońska 4, 71-455 Szczecin, Poland https://orcid.org/0009-0007-7338-3670

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.5722

Keywords:

End-Stage Liver Disease, Liver Transplantation, Prehabilitation, Frailty, Sarcopenia, Physical Performance

Abstract

End-stage liver disease (ESLD) is associated with significant metabolic disturbances, including chronic inflammation, hypercatabolism, and impaired protein synthesis, which lead to the development of sarcopenia and frailty. These conditions are common among patients qualified for liver transplantation and represent independent risk factors for waitlist mortality, postoperative complications, and prolonged hospitalization.

Prehabilitation, defined as a multimodal intervention including physical training, nutritional optimization, and psychological support, aims to improve the patient’s physiological reserve prior to surgery. The aim of this study was a systematic evaluation of the available evidence regarding prehabilitation in liver transplant candidates, with particular emphasis on its impact on physical performance and clinical outcomes.

Available data indicate that prehabilitation improves performance parameters such as VO₂peak and the 6-minute walk distance. However, its impact on hard clinical endpoints, including mortality and postoperative complications, remains inconclusive.

Prehabilitation appears to be a safe and potentially beneficial intervention, particularly in frail patients; however, further high-quality studies are required.

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