![]() ![]() ( 1– 3) In transplant hepatology, a consensus toolkit for the measurement of frailty using 4 easily administered tests (the Karnofsky Performance Index, the Activities of Daily Living scale, the Liver Frailty Index, and the 6-minute walk test distance) was suggested by a consensus statement endorsed by the American Society of Transplantation. ![]() In this review, we will consider the key events that may impact the extent and rapidity of recovery over time of physical and metabolic functionality and activity-related QOL after liver transplantation.Ĭirrhosis leads to muscle wasting, malnutrition, and functional impairments that manifest as the clinical phenotype of physical frailty, with increased risk of transplant wait-list mortality. Those who have accepted and lived within the limitations of end-stage liver disease for years may harbor an unrealistically low or a falsely high expectation of the extent of improvement they are likely to experience after transplantation. Increasing physical activity and improving physical function are the primary modifiable risk factors for this major problem, along with learning the factors that may result in a recipient adopting either a vigorous or sedentary posttransplant physical activity profile. ![]() There is now ample evidence that liver transplant recipients have a high prevalence of the metabolic syndrome and its complications, especially cardiovascular morbidity. ![]() In contrast, however, the new issues that liver recipients face in recovering and sustaining full function and quality of life (QOL) extend for decades. Pretransplant care is focused on solving the immediate problems that persons who need a liver transplant must overcome, typically over a duration of a year or less. Its effects range from impacts on molecular and physical events to changes in personal outlook, resilience, and relationships. Liver transplantation is an inflection point in a recipient’s life. At present, it is reasonable for transplant teams to assess fitness and design a tailored exercise program when a recipient is first discharged, to record and reinforce progress at all posttransplant visits, and to set realistic longterm performance goals that will often achieve recommended standards for the healthy general population. Developing evidence-based standards for post–liver transplant physical activity baseline testing and sustainment of intensity and quality is a key unmet need in transplant hepatology. Importantly, 1 controlled trial found that exercise also improved quality of life (QOL) measured by the Short Form 36 survey, consistent with multiple reports of the value of social support and engagement in sports activity for improving posttransplant QOL. Posttransplant exercise improves fitness, which is a conclusion based on 2 observational studies and 3 randomized trials that assessed endpoints of strength testing, energy expenditure in metabolic equivalents, and peak or maximal oxygen uptake. Anatomic measurements of sarcopenia and the physical performance indicators of frailty both tend to improve slowly, and they may, in fact, decrease further in the posttransplant period, especially when the common extrahepatic drivers of muscle loss, such as the elements of the metabolic syndrome, persist or intensify after transplantation. Although transplantation normally enables rapid recovery of liver synthetic and metabolic functions, the recovery of physical capacity and performance to normal levels is delayed and often incomplete. Robust physical activity after liver transplantation is an important determinant of longterm health, similar in its importance to the value of pretransplant activity for withstanding the immediate stress of transplantation. ![]()
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