A randomized, controlled, prehabilitation intervention to maximize early recovery (PRIMER) in liver transplantation.
Serper, M., et al.Liver Transplantation 2023 [record in progress].
Aims
This study aimed to assess the feasibility, acceptability and efficacy of a 14-week behavioural intervention targeted at promoting physical activity prior to receiving a liver transplant (LT).
Interventions
Participants were randomised to either the intervention arm in which patients received a home-based physical activity program or to the control arm.
Participants
30 patients either undergoing LT evaluation, waitlisted for LT, or completed LT evaluation but not yet waitlisted due to clinical stability.
Outcomes
The primary endpoints were feasibility and acceptability. Secondary endpoints were end-of-study step counts, end-of-study Short Physical Performance Battery (SPPB) performance, body composition and grip strength.
Follow-up
14 weeks postenrollment.
CET Conclusions
Prehabiliation programs have been employed in many surgical patient groups to improve peri-operative outcomes but have showed low compliance in liver failure patients awaiting transplantation. This randomised trial evaluates the feasibility of implementing a prehabilitation program with financial incentives to participants for meeting exercise goals. The study demonstrated a significantly improved rate of compliance compared to other studies, but at an average cost of $200 per patient in incentive payments. The authors argue that this cost can be justified by potential future savings in terms of reduced admissions. However, the long-term outcomes analysed in this study (mortality, rate of transplantation) showed no difference between groups. With severe fatigue and sarcopaenia being predominant features of liver disease, it is unlikely that prehabilitation programs would be feasible and efficacious in this patient group.
Data analysis
Available case analysis
Trial registration
Clinicaltrials.gov - NCT03584646