Prehabilitation for kidney transplant candidates: Is it time?

Abstract

Many patients become frail with diminished cardiorespiratory fitness while awaiting kidney transplantation. Frailty and poor fitness powerfully predict mortality, transplant graft survival, and healthcare utilization after kidney transplantation. Efforts to intervene with post‐transplant physical therapy have been met with limited success, in large part due to high study dropout. We reviewed the literature on chronic kidney disease and exercise to propose a clinical framework for physical therapy interventions to improve fitness, scheduled for before the transplant. This framework may lead to better patient retention and compliance, and thus demonstrate better efficacy in mitigating the effects of frailty and poor fitness after kidney transplantation.

Association of Karnofsky Performance Status with waitlist mortality among older and younger adults awaiting kidney transplantation

“…However, its advantage is that it is very easy and quick to use in clinical practice and may serve as a useful screening tool to rapidly identify younger, more impaired candidates or older, more robust patients for further risk stratification through the use of more objective measures of physical function, or more comprehensive geriatric assessment, which in turn can be used to guide multidisciplinary interventions on functional status prior to transplantation. Prehabilitation through use of outpatient physical therapy sessions has already been successfully piloted in kidney transplant, and trials of other interventions should also be considered …”

Frailty phenotypes and mortality after lung transplantation: A prospective cohort study

“…In 15 subjects with COPD or pulmonary fibrosis, we reported in abstract form that treating frailty was safe and, for some of the participants, SPPB frailty scores improved (61). These studies suggest that implementing targeted interventions before transplantation to optimize pre-operative functional status ( i.e., “pre-habilitation”) could reverse components of the frailty phenotype; ideally, doing so would then reduce subsequent morbidity and mortality (62–64). …”

“…61 These studies suggest that implementing targeted interventions before transplantation to optimize preoperative functional status (ie, "prehabilitation") could reverse components of the frailty phenotype; ideally, doing so would then reduce subsequent morbidity and mortality. [62][63][64] Our study had limitations and also raises several important could have impacted the severity of their frailty status. We did not have access to reliable records of the amount and type of exercises subjects were performing during the waitlist period.…”

Pre-kidney transplant lower extremity impairment and transplant length of stay: a time-to-discharge analysis of a prospective cohort study

“…There is evidence that patients with higher physical functional capabilities before a surgical intervention will better tolerate a procedure such as KT. For example, a recent review of the literature by Cheng et al identified a growing body of evidence documenting improved outcomes in cardiopulmonary fitness with exercise training in patients after cardiothoracic and orthopedic surgeries, including post-cardiac transplantation [ 39 ]. There is also evidence that most nephrologists, geriatricians, transplant surgeons, and ESRD patients agree that prehabilitation could make ESRD patients less frail [ 40 ].…”