Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.
Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada.
Clin Transplant. 2022 Sep;36(9):e14706. doi: 10.1111/ctr.14706.
The indication and surgical complexity of orthotopic liver transplantation underscore the need for strategies to optimize the recovery for transplant recipients. We conducted a systematic review aimed at identifying, evaluating, and synthesizing the evidence examining the effect of in-patient rehabilitation for liver transplant recipients and provide related practice recommendations.
Health research databases were systematically reviewed for studies that included adults who received liver transplantation and participated in acute, post-transplant rehabilitation. Postoperative morbidity, mortality, length of hospital stay, length of intensive care unit stay, and other markers of surgical recovery were extracted. Practice recommendations are provided by an international panel using GRADE.
Twelve studies were included in the review (including 3901 participants). Rehabilitation interventions varied widely in design and composition; however, details regarding intervention delivery were poorly described in general. The quality of evidence was rated as very low largely owing to "very serious" imprecision, poor reporting, and limited data from comparative studies. Overall, the studies suggest that in-patient rehabilitation for recipients of liver transplantation is safe, tolerable, and feasible, and may benefit functional outcomes.
Two practice recommendations related to in-patient rehabilitation following LT were yielded from this review: (1) it is safe, tolerable, and feasible; and (2) it improves postoperative functional outcomes. Each of the recommendations are weak and supported by low quality of evidence. No recommendation could be made related to benefits or harms for clinical, physiological, and other outcomes. Adequately powered and high quality randomized controlled trials are urgently needed in this area.
原位肝移植的适应证和手术复杂性突出了需要制定策略来优化肝移植受者的恢复。我们进行了一项系统评价，旨在确定、评估和综合评估检查肝移植受者住院康复效果的证据，并提供相关的实践建议。
系统检索健康研究数据库，以确定纳入成年人接受肝移植并参与急性术后康复的研究。提取术后发病率、死亡率、住院时间、重症监护病房住院时间和其他手术恢复标志物。国际小组使用 GRADE 提供实践建议。
共纳入 12 项研究（包括 3901 名参与者）。康复干预措施在设计和组成上差异很大；但是，一般来说，干预措施的实施细节描述很差。证据质量被评为非常低，主要是因为“非常严重”的不精确性、报告质量差和来自比较研究的数据有限。总的来说，这些研究表明，肝移植受者的住院康复是安全、可耐受和可行的，并且可能有益于功能结果。
本综述产生了两项与 LT 后住院康复相关的实践建议：（1）它是安全、可耐受和可行的；（2）它改善术后功能结果。这两条建议都很弱，证据质量也很低。在临床、生理和其他结果方面，没有关于益处或危害的建议。在这一领域迫切需要进行足够大样本量和高质量的随机对照试验。
