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Online Prehabilitation for Patients Awaiting Liver Transplantation

Cirrhosis, Liver

Physical frailty is common in patients awaiting liver transplantation and has been associated with poor health outcomes. There is promising data from small studies showing that behavioural, nutrition and exercise therapy (prehabilitation) improves physical function in patients while they are waiting for a liver transplant.

The proposed trial will assess if a 12-week online prehabilitation program improves physical function in patients listed for liver transplantation. Over 4 years, 221 patients will be recruited from 5 transplant centres across Canada and will be randomized to receive either the online prehabilitation program or usual care.

The primary outcome will be the change in distance walked in 6 minutes between the beginning and end of the study. Secondary and exploratory outcomes include changes in the liver frailty intake, health-related quality of life, covert hepatic encephalopathy, and post-transplant health- related outcomes.

Results will be compared between the intervention and usual care groups. If feasible, an economic evaluation will compare the costs and benefits of the prehabilitation program versus usual care.

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Participation Requirements

  • Sex:

    ALL

  • Eligible Ages:

    18 and up

Participation Criteria

Inclusion Criteria:

* Adults ≥18 years old with cirrhosis (compatible fibroscan, histology or imaging based assessment + compatible clinical picture)
* Listed or being worked up with a high likelihood to be listed for LT
* Are pre-frail (liver frailty index (LFI) 3.2-4.3) or frail (LFI ≥4.4)
* Have English or French language proficiency
* Own an internet-connected device

Exclusion Criteria:

* Listed for living related donor transplantation with expected time on the wait list \<12 weeks, or model for end-stage liver disease (MELD-Na) Score \>26 (Justification: time to transplant is very short)
* Robust status on frailty testing (LFI 0-3.1) (Justification: unlikely to see benefit)
* Unable to provide informed consent
* Presence of a clinical condition that makes the intervention unsafe or infeasible (e.g. unable to follow instruction) or unsafe environment for virtual participation
* Life expectancy less than 6 months, compassionate care (clinician judgment) (Justification: unlikely to see benefit)
* Recent variceal bleed or history of varices not on adequate prophylaxis (Justification: acute exercise increases portal pressure
* Transplant indication is cholangiocarcinoma.

Study Location

Kaye Edmonton Clinic
Kaye Edmonton Clinic
Edmonton, Alberta
Canada

Contact Study Team

Primary Contact

Puneeta Tandon, MD

[email protected]
780-492-9844
Study Sponsored By
University of Alberta
Participants Required
More Information
Study ID: NCT05899231