Benmassaoud Amine, Martel Myriam, Carli Franco, Geraci Olivia, Daskalopoulou Stella S, Sebastiani Giada, Bessissow Amal
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada.
Research Institute of the McGill University Health Centre, Montreal, Canada.
Transplant Rev (Orlando). 2024 Apr;38(2):100835. doi: 10.1016/j.trre.2024.100835. Epub 2024 Feb 15.
Frailty, malnutrition and sarcopenia lead to a significant increase in morbidity and mortality before and after liver transplantation (LT). Prehabilitation attempts to optimize physical fitness of individuals before major surgeries. To date, little is known about its impact on patients awaiting LT.
The aim of our scoping review was to describe whether prehabilitation in patients awaiting LT is feasible and safe, and whether it leads to a change in clinical parameters before or after transplantation.
We performed a systematic review of the literature from 1946 to November 2023 to identify prospective studies and randomized controlled trials of adult LT candidates who participated in an exercise training program.
Out of 3262 citations initially identified, six studies were included. Studies were heterogeneous in design, patient selection, intervention, duration, and outcomes assessed. All studies were self-described as pilot or feasibility studies and had a sample size ranging from 13 to 33. Two studies were randomized controlled trials. Two study restricted to patients with cirrhosis who were eligible for liver transplantation or on the transplant list. Exercise programs lasted between 6 and 12 weeks. In terms of feasibility, proportion of eligible patients that were recruited was between 54 and 100%. Program completion ranged between 38 and 90%. Interventions appeared safe with 9 (9.2%) adverse events noted. In the intervention group, improvements were generally noted in peak oxygen consumption and workload, 6-min walking distance, and muscle strength. One study suggested a decrease in post-transplant hospital length of stay.
Overall, it appears that prehabilitation with exercise training is feasible, and safe in patients awaiting LT. Higher quality and larger studies are needed to confirm its impact on pre- and post-transplantation-related outcomes.
衰弱、营养不良和肌肉减少症会导致肝移植（LT）前后发病率和死亡率显著增加。术前康复旨在优化个体在重大手术前的身体素质。迄今为止，关于其对等待肝移植患者的影响知之甚少。
我们的范围综述旨在描述等待肝移植患者的术前康复是否可行且安全，以及它是否会导致移植前后临床参数的变化。
我们对1946年至2023年11月的文献进行了系统综述，以确定参与运动训练计划的成年肝移植候选者的前瞻性研究和随机对照试验。
在最初确定的3262篇文献中，纳入了6项研究。这些研究在设计、患者选择、干预、持续时间和评估结果方面存在异质性。所有研究均自称是试点或可行性研究，样本量从13到33不等。两项研究为随机对照试验。两项研究仅限于符合肝移植条件或在移植名单上的肝硬化患者。运动计划持续6至12周。在可行性方面，招募的符合条件患者比例在54%至100%之间。计划完成率在38%至90%之间。干预措施似乎是安全的，记录到9例（9.2%）不良事件。在干预组中，通常在峰值耗氧量、工作量、6分钟步行距离和肌肉力量方面有改善。一项研究表明移植后住院时间缩短。
总体而言，运动训练的术前康复在等待肝移植的患者中似乎是可行且安全的。需要更高质量和更大规模的研究来证实其对移植前后相关结果的影响。
