We report results of a randomized clinical trial of a combined intervention of exercise and dietary counseling (ExD) after orthotopic liver transplantation (OLT).Of the 151 patients randomized into ExD or usual care (UC), 119 completed testing 2, 6 and 12 months post-OLT. Testing included assessment of exercise capacity (VO 2peak ), quadricep muscle strength, body composition (DXA), nutritional intake (Block 95) and health-related quality of life (SF-36). The intervention consisted of individualized counseling and follow-up to home-based exercise and dietary modification. Repeated measure ANOVA was performed to determine differences over time between ExD and UC with a secondary analysis to determine differences over time between adherers (Adh), nonadherers (Nadh) to the intervention and UC. The ExD group showed greater increases in VO 2peak (p = 0.036), and self-reported general health (p = 0.038) compared to UC. Both groups demonstrated increases in muscle strength, body weight, body fat and other SF-36 scale scores. Adherence to the intervention was 37% with positive trends in VO 2peak and body composition observed in Adh compared to Nadh and UC. These data suggest improvements in exercise capacity and body composition are achieved with nutrition and exercise behavior modifications initiated early after OLT and with regular follow-up.

Many studies have reported improved health-related quality of life (HRQoL) from pre- to immediate post-orthotopic liver transplantation (OLT). However, few studies have evaluated longitudinal changes over the first 2 yr post-OLT and none have simultaneously examined objective measures of health-related fitness. A total of 50 OLT recipients (32 males,18 females; 51.4 +/- 11.8 yr) completed testing at 2, 6, 12, and 24 months post-OLT. Testing included assessment of exercise capacity (peak VO2), quadriceps muscle strength, body composition, physical activity participation, and self-reported functioning (SF-36). Repeated measures of analysis of variance (ANOVA) with post hoc contrasts was performed to determine differences over time and a second ANOVA assessed differences over time between genders. All patients increased peak VO2, quadriceps muscle strength, and percent body fat (p < 0.0001) from 2 to 24 months. Men and women differed in their changes of peak VO2 and percent body fat (p < 0.05). At 24 months, only 50% of the patients reported participating in regular physical activity. All SF-36 physical measures except general health, improved from 2 to 24 months (p < 0.0001). Measures of health-related fitness and QoL improve over the first 2 yr post-OLT with the greatest gains occurring in the first 6 months and all measures remain lower than recommended for cardiovascular and overall health. A randomized clinical trial of lifestyle modifications such as diet and exercise intervention is warranted to determine the impact of such modifications on HRQoL and fitness post-OLT.

End-stage liver disease (ESLD) affects thousands of people in the United States annually. Improvements in survival after liver transplantation have broadened the indications for its use as a proven therapy for ESLD, rapidly increasing the number of transplant candidates. However, the number of patients awaiting transplantation far surpasses the donor supply, resulting in lengthy waiting times. During this wait, these patients experience progressive disease-related decompensation that is often accompanied by malnutrition and reduced physical activity. This chronic disease triad can have profound effects on musculoskeletal complications, such as cachexia and osteoporosis. In the absence of proper interventional strategies before transplantation, these complications can intensify after the transplantation, as a result of continued poor nutrition intake, bed rest, and pharmacotherapies. This article discusses levels of physical functioning and nutrition status in both the pre-and post-transplant populations, the risks associated with current levels, and the roles that diet and activity therapies can have to improve outcomes.

Recent advancements in pharmacotherapies and medical technologies have significantly improved long‐term survival rates after liver transplantation. However, as survival rates increase, so do incidences of other chronic diseases more commonly associated with advanced age. In fact, as a population, post‐liver‐transplant patients are at greater risk for cardiovascular disease, diabetes mellitus, cancer, and osteoporosis than the general public. Moreover, disease risk factors such as hyperglycemia, dyslipidemia, hypertension, and excess weight gain continue to plague this population despite reduced‐dose requirements for immunosuppressives—a class of drugs with numerous side effects—which, historically, were thought to contribute heavily to chronic disease risk. Thus, clinicians treating liver‐transplant candidates are challenged to broaden the scope of their care to include prevention of other chronic diseases that may have strong nutritional components. Although nutrition and medical therapies should continue to treat specific symptoms associated with the stages of liver disease and transplantation, therapies and information provided to pre‐transplant patients should include preventative measures to ensure optimal outcomes for improved longevity after transplant. The medical team should utilize the nutritional expertise of dietitians to lead this continuity of care through all stages of liver transplantation. To maximize longevity and quality of life, dietary intervention for chronic disease prevention should be implemented as soon as medically feasible. This paper reviews nutrition therapies for complications seen during liver transplantation and proposes individualized diet recommendations to be considered at the very earliest stages of caring for patients with liver disease.

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