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884 - The Role of Rehabilitation Across the Continuum of Liver Disease from Cirrhosis to Transplantation and Beyond: A Narrative Review

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

Laura J. Malmut, MD

Medical Director of Transplant Rehabilitation, Assistant Professor, Associate Clerkship Director
MedStar National Rehabilitation Hospital and Georgetown University School of Medicine
Washington, District of Columbia, United States

Co-Author(s)

Leslie Rydberg, MD

Associate Professor, Clerkship Director, Associate Residency Program Director
Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Jacqueline D. Neal, MD (she/her/hers)

Attending Physician/Associate Professor
Jesse Brown VA Medical Center/Northwestern University
Chicago, Illinois, United States
Sarah M. Eickmeyer, MD (she/her/hers)

Professor
KU Medical Center
Kansas City,, Kansas, United States
Julie Lanphere, DO (she/her/hers)

Attending Physician
Intermountain Neurosciences Institute
Murray,, Utah, United States
Kim Barker, MD (she/her/hers)

Associate Professor
UT Southwestern
Dallas, Texas, United States

Objectives: Chronic liver disease is a major cause of morbidity and mortality across the globe. Cirrhosis causes alterations in metabolic and circulatory functions that negatively impact nutritional status and exercise capacity. Physical rehabilitation for the management of chronic disease has shown positive effects on many patient-related outcomes including morbidity, mortality, physical function, and quality of life. This literature review explores the impact of rehabilitative interventions at each stage of liver disease from cirrhosis to transplantation and beyond.

Design: A literature search was conducted in Medline, Embase, and Google Scholar databases using keywords and phrases including (“liver transplant” OR “liver disease” OR cirrhosis OR “liver failure”) AND (rehabilitation OR exercise OR “physical function” OR physiology OR outcomes OR frailty). Articles were included if they were identified in one of the three databases, written in English, peer-reviewed, and involved human subjects without any restrictions on the publication date.

Results: This search strategy resulted in 76 total articles, which included original research and review articles. The literature indicated that frailty is identified in nearly half of patients with advanced liver disease and bears a poor prognosis. Exercise and nutritional interventions improve key components of physical frailty and quality of life in chronic liver disease and after liver transplantation. Early mobility is generally recommended following liver transplantation and deemed to be safe and feasible. Inpatient rehabilitation may be considered in patients who require ongoing daily medical management and have functional goals. Transplantation improves function but not to the level of the general population.

Conclusions:

Rehabilitation is safe and improves outcomes at every stage of liver disease from cirrhosis to following transplantation. There is ample data published on frailty and prehabilitation. Additional research is needed to inform outcomes and rehabilitation interventions in the perioperative period, inpatient rehabilitation period, and long-term.