Home-based prehabilitation for frail patients awaiting liver transplant: preliminary results of the Fit4Cirrhotics@home Study

Background
Reduced aerobic capacity predicts poor postoperative outcomes in liver transplant candidates. While exercise is safe and effective, adherence remains a challenge. Home-based prehabilitation may improve participation, especially when tailored to the patient's fitness level.

Objective
To evaluate the effectiveness and feasibility of a home-based, bimodal (exercise + nutrition) prehabilitation program in frail patients with liver cirrhosis awaiting transplantation.

Methods
This prospective study started in October 2024 and includes patients with reduced aerobic capacity. The intervention combines high-intensity interval training and endurance training based on Steep Ramp Test results, resistance exercises, inspiratory muscle training, and protein supplementation.
Primary outcome: VO₂ at ventilatory threshold and VO₂peak.
Secondary outcomes: muscle mass (ultrasound, SARC-F, Liver Frailty Index), functional mobility, fatigue, quality of life, hepatic encephalopathy, microbiome, blood biomarkers, and postoperative outcomes. Feasibility is assessed through participation, adherence and safety.

Results
Of 41 screened patients, 8 were eligible and included; others were mostly too fit or ineligible. Three underwent transplantation before retesting. Among the remaining, adherence varied due to disease-related instability, yet several showed measurable improvement in aerobic capacity and muscle function. Home training combined with remote support proved acceptable and motivating for both patients and care teams. Technical monitoring allowed timely feedback and support, potentially enhancing adherence.

Conclusion
Home-based prehabilitation appears feasible and beneficial in selected, vulnerable liver transplant candidates. Inclusion continues toward a target of 24 patients.