Feasibility, safety, and effectiveness of prehabilitation programs in patients awaiting liver transplantation: A systematic review and meta-analysis.

Patients awaiting liver transplantation (LT) are often frail, malnourished, and at risk of poor health outcomes. Prehabilitation programs (exercise, nutrition, and psychological interventions) attempt to mitigate these comorbidities. This study assesses the feasibility, safety, and effectiveness of such programs as primary outcomes, and their impact on physical fitness and health pre- and post-LT as secondary outcomes. We conducted a systematic review and meta-analysis and searched EMBASE, MEDLINE, CINAHL, ISI Web of Science, and CENTRAL. We included primary studies from database inception to March 2025 of adults listed for LT enrolled in prehabilitation programs. From 4762 citations, 19 studies were included. Participation in a prehabilitation program was 66% (48% to 80%; 12 studies, n = 1120). Prehabilitation program completion was 75% (61% to 85%; 17 studies, n = 862), and it did not differ from completion in control groups (risk ratio 0.98, 0.95 to 1.02; 12 studies, n = 753). Adverse events were 4% (2% to 9%) (8 studies, n = 154). Physical fitness demonstrated improvement from preintervention to postintervention in VO2 (standard mean difference [SMD] = 0.63 [0.02 to 1.23]), 6-minute walk test (SMD = 0.71 [0.19 to 1.22]), liver frailty index (SMD = -0.57 [-0.90 to -0.24]), and Short Physical Performance Battery (SMD = 0.88 [0.35 to 1.42]). Prehabilitation programs appear feasible and safe, with significant improvements in exercise fitness.