European Society of Organ Transplantation (ESOT) Consensus Statement on Prehabilitation for Solid Organ Transplantation Candidates

Abstract

There is increasingly growing evidence and awareness that prehabilitation in waitlisted solid organ transplant candidates may benefit clinical transplant outcomes and improve the patient’s overall health and quality of life. Lifestyle changes, consisting of physical training, dietary management, and psychosocial interventions, aim to optimize the patient’s physical and mental health before undergoing surgery, so as to enhance their ability to overcome procedure-associated stress, reduce complications, and accelerate post-operative recovery. Clinical data are promising but few, and evidence-based recommendations are scarce. To address the need for clinical guidelines, The European Society of Organ Transplantation (ESOT) convened a dedicated Working Group “Prehabilitation in Solid Organ Transplant Candidates,” comprising experts in physical exercise, nutrition and psychosocial interventions, to review the literature on prehabilitation in this population, and develop recommendations. These were discussed and voted upon during the Consensus Conference in Prague, 13–15 November 2022. A high degree of consensus existed amongst all stakeholders including transplant recipients and their representatives. Ten recommendations were formulated that are a balanced representation of current published evidence and real-world practice. The findings and recommendations of the Working Group on Prehabilitation for solid organ transplant candidates are presented in this article.

Rehabilitation interventions to modify physical frailty in adults before lung transplantation: a systematic review protocol

“…Exercise is defined as a subset of physical activity that is planned, structured and repetitive and has an objective of the improvement or maintenance of physical fitness 31. Multimodal and multicomponent interventions in this population are clinically important due to the need to address the complex interaction between the physical and psychological health of the patient prior to transplantation 22…”

Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet?

“…These initial studies indicated that (i) exercise-based prehabilitation is safe, (ii) kidney transplant candidates consider exercise-based prehabilitation appropriate, acceptable, satisfying, and effective to improve physical function, and (iii) exercise-based prehabilitation improves physical function, cardiorespiratory fitness, muscle strength, physical activity levels, fatigue, frailty, body composition, and postoperative length of stay [28–31]. Recently, a consensus meeting on prehabilitation for solid organ transplant candidates was held under the flag of the European Society of Organ Transplantation (ESOT) [32 ▪ ]. Recommendations from this meeting stated that given the limited body of literature evidence, high-quality studies on prehabilitation in solid organ transplant candidates are needed, in which both the effectiveness and implementation of pretransplant multimodal prehabilitation are addressed.…”

“…Recommendations from this meeting stated that given the limited body of literature evidence, high-quality studies on prehabilitation in solid organ transplant candidates are needed, in which both the effectiveness and implementation of pretransplant multimodal prehabilitation are addressed. In addition, it was recommended that a Core Outcome Set and preferred assessment methodology should be developed to enable adequate comparison of the study results and identify the optimal modality, timing, duration, and delivery characteristics of prehabilitation interventions [32 ▪ ]. At the moment, two RCT's on multimodal prehabilitation interventions in people living with CKD who are also waitlisted for transplantation are underway: the FRAIL-MAR-study (NCT04701398) [33] and the PreCareTx-study (NCT05489432) [34].…”

Using Digital Health Interventions to Promote Prehabilitation Prior to Kidney Transplantation

“…1 Prehabilitation is now gradually considered to be an essential part of the enhanced recovery pathway for those receiving kidney transplantation. 2 A recently published multi-center clinical trial from the UK by Greenwood and colleagues 3 concluded positive findings on evaluating the effects of a digital health intervention (Kidney BEAM) to enhance physical activity in people with CKD including transplant waitlist patients. In particular, the Kidney BEAM physical activity platform demonstrated to significantly improve mental health-related quality of life in patients with CKD.…”

“…1 Prehabilitation is now gradually considered to be an essential part of the enhanced recovery pathway for those receiving kidney transplantation. 2…”