Better in, better out: advancing transplant care through prehabilitation and rehabilitation: towards a multimodal continuum of care before and after solid organ transplantation.

PURPOSE OF REVIEW: Solid organ transplantation is life-saving but imposes substantial physical and psychological demands across the pre, peri-, and posttransplant trajectory. Emerging evidence highlights the potential of prehabilitation and rehabilitation to enhance resilience before surgery, support recovery afterward, and reduce surgical and medical complications, ultimately improving long-term health after transplantation. Despite growing evidence of their benefits, these strategies remain underutilized in transplant care. This review aims to introduce multimodal continuum of care that integrates prehabilitation and rehabilitation into a unified pathway before and after transplantation to optimize outcomes in solid organ transplantation.

RECENT FINDINGS: Multimodal programs combining exercise, nutrition, and psychosocial support have demonstrated reductions in complications, shorter hospital stays, and improved survival and quality of life in surgical populations, with emerging evidence in transplantation. Consensus statements advocate individualized, adaptive interventions across the transplant continuum, delivered by interdisciplinary teams. Leveraging the same multidisciplinary team before and after transplantation fosters consistency, efficiency, and patient engagement-critical for adherence and empowerment.

SUMMARY: Although high-quality transplant-specific evidence remains limited, targeted, multimodal prehabilitation and rehabilitation represent promising strategies to enhance functional capacity and long-term health. We therefore propose "better in, better out" as a guiding principle for transplant care, calling for its adoption as a new standard supported by emerging evidence across kidney, liver, lung, and heart transplantation.