Internal Medicine Residency Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Am J Gastroenterol. 2021 Oct 1;116(10):2105-2117. doi: 10.14309/ajg.0000000000001376.
Frailty is a predictor of morbidity and mortality in cirrhosis. Although evidence for prehabilitation is promising, the data for liver transplant (LT) candidates are limited. The primary aim of this study was to evaluate the effect of a novel prehabilitation strategy on changes in frailty metrics and survival in LT candidates. The secondary aim was to determine liver-related and extrahepatic conditions associated with frailty.
In this ambispective cohort study, all patients underwent frailty assessment using the liver frailty index (LFI), 6-minute walk test, and gait speed test performed by a dedicated physical therapist. Home-based exercise prescription was individualized to each patient's baseline physical fitness.
We included 517 patients (59% men, median age 61 years, and a model for end-stage liver disease score of 12) evaluated during 936 PT visits. Frailty metrics were affected by age, sex, and liver-related parameters, but not by model for end-stage liver disease. Patients with nonalcoholic fatty liver disease and alcohol-related cirrhosis had worse frailty metrics by all tools. We demonstrated the feasibility of prehabilitation in improving both LFI and 6-minute walk test, particularly in adherent patients. A median LFI improvement of 0.3 in frail patients was associated with improved survival in univariate analysis. Compliance with physical therapist visits (hazards ratio = 0.35 [0.18-0.67] for 2 visits and hazards ratio = 0.54 [0.31-0.94] for ≥3 visits) was independently associated with increased survival.
Prehabilitation improves frailty metrics in LT candidates and is associated with a survival advantage. Our findings provide a framework for the standardized prehabilitation program in LT candidates while prioritizing compliance, adherence, and on-training LFI goal accomplishment.
衰弱是肝硬化患者发病率和死亡率的预测因素。尽管预康复的证据很有前景，但肝移植（LT）患者的数据有限。本研究的主要目的是评估一种新的预康复策略对 LT 患者虚弱指标和生存率的影响。次要目的是确定与虚弱相关的肝脏和肝脏外情况。
在这项前瞻性队列研究中，所有患者均由专门的物理治疗师进行衰弱评估，使用肝脏衰弱指数（LFI）、6 分钟步行测试和步态速度测试。根据每个患者的基础体能制定个体化的家庭运动处方。
我们纳入了 517 名患者（59%为男性，中位年龄 61 岁，终末期肝病模型评分 12），在 936 次 PT 就诊期间进行了评估。衰弱指标受年龄、性别和肝脏相关参数的影响，但不受终末期肝病模型的影响。非酒精性脂肪性肝病和酒精性肝硬化患者的所有工具均显示出较差的衰弱指标。我们证明了预康复在改善 LFI 和 6 分钟步行测试方面的可行性，特别是在坚持治疗的患者中。虚弱患者的 LFI 中位数改善 0.3 与单因素分析中的生存率提高相关。与物理治疗师就诊次数的依从性（就诊 2 次的风险比=0.35[0.18-0.67]；就诊≥3 次的风险比=0.54[0.31-0.94]）独立相关，可提高生存率。
预康复可改善 LT 候选者的衰弱指标，并与生存优势相关。我们的研究结果为 LT 候选者的标准化预康复计划提供了框架，同时优先考虑依从性、坚持性和训练中 LFI 目标的实现。
