Department of Anesthesiology, Erasmus University Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands.
Department of Surgery, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Transpl Int. 2022 Sep 8;35:10330. doi: 10.3389/ti.2022.10330. eCollection 2022.
Prehabilitation improves surgical outcomes in patients undergoing surgery. However, patients preparing for orthotopic liver transplantation (OLT) are physically "frail" and suffer from comorbidities that generally hamper physical activity. This systematic review aims to evaluate the physical effects, safety and feasibility of prehabilitation in OLT candidates. Relevant articles were searched, in Embase, Web of Science, Cochrane, Medline and Google Scholar, to December 2021. Studies reporting on specified preoperative exercise programs, including adult OLT candidates with end-stage liver disease, with a model for end-stage liver disease (MELD) score ≥12 or Child-Pugh classification B/C, were included. This resulted in 563 potentially eligible studies, out of which eight were selected for inclusion, consisting of 1,094 patients (male sex 68%; mean age 51-61 years; mean MELD score 12-21). Six of the included studies were classified as low-quality by the GRADE system, and three studies had high risk for ineffectiveness of the training program according to the i-CONTENT tool. Significant improvement was observed in VO2 peak, 6-minute walking distance, hand grip strength, liver frailty index and quality of life. Feasibility ranged from an adherence of 38%-90% in unsupervised-to >94% in supervised programs. No serious adverse events were reported. In conclusion, prehabilitation in patients awaiting OLT appears to improve aerobic capacity, and seems feasible and safe. However, larger clinical trials are required to accurately examine the preoperative and postoperative effects of prehabilitation in this specific patient population.
术前康复可改善接受手术的患者的手术结果。然而，准备接受原位肝移植（OLT）的患者身体“虚弱”，并患有多种合并症，这些合并症通常会阻碍他们的身体活动。本系统评价旨在评估 OLT 候选者术前康复的身体影响、安全性和可行性。检索了 Embase、Web of Science、Cochrane、Medline 和 Google Scholar 中的相关文章，截至 2021 年 12 月。研究报告了特定的术前运动方案，包括终末期肝病的成年 OLT 候选者，终末期肝病模型（MELD）评分≥12 或 Child-Pugh 分类 B/C，包括在内。这导致 563 项潜在合格的研究，其中 8 项被选入研究，共包括 1094 名患者（男性占 68%；平均年龄 51-61 岁；平均 MELD 评分 12-21）。纳入的 6 项研究被 GRADE 系统评为低质量，3 项研究根据 i-CONTENT 工具被认为训练计划无效的风险较高。VO2 峰值、6 分钟步行距离、握力、肝脏脆弱指数和生活质量均显著改善。可行性范围从非监督性的 38%-90%到监督性方案的>94%。未报告严重不良事件。总之，OLT 等待者的术前康复似乎可以提高有氧运动能力，并且似乎是可行且安全的。然而，需要更大的临床试验来准确检查术前和术后康复对这一特定患者群体的影响。
