Liver transplantation surgery is a life-saving treatment option for life-threatening end-stage liver diseases and acute liver failure. While the healthrelated quality of life of liver transplant recipients is related to the success of the transplantation procedure; fatigue, malnutrition, loss of muscle mass, decrease in exercise capacity, negative respiratory and metabolic changes as the findings of organ failure are among the causes of functional loss in the posttransplant period. The prevalence of the fatigue, as the frequently experienced symptom in the end-stage liver diseases, varies depending on the specific forms of liver disease and it adversely affects pre and postoperative functional levels of the patients, liver transplantation results and also survival. The severity of the fatigue decreases after the transplantation surgery, but it continues to be seen as the most compelling clinical symptom experienced during the postoperative first year. Current literature data emphasize the necessity of physiotherapy programs and active early mobilization which applied in the early period in the intensive care unit following transplantation surgery and physiotherapy and rehabilitation approaches including strength and endurance training contributes to the functional level in this population. These findings suggest that there is a need for structured physiotherapy programs to increase muscle strength and exercise capacity and prevent fatigue.

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Purpose: Exercise capacity is a well known prognostic indicator in many clinical conditions. This study evaluates the clinical and exercise variables most determinant for estimating exercise capacity in liver transplant candidates. Methods:This prospective cross-sectional study consisted of thirty patients who were scheduled for liver transplantation. Respiratory and peripheral muscle strengths were measured using a mouth pressure device and a hand-held dynamometer, respectively. Physical activity, fatigue, exercise capacity, physical performance, and quality of life of participants were assessed using the International Physical Activity Questionnaire, the Turkish version of the Checklist Individual Strength Questionnaire, the Six-minute Walk Test (6MWT), the 30-sec Sit-to-Stand Test, and the Liver Disease Symptom Index 2.0, respectively. Multivariate analysis was conducted to determine clinical factors predictive of exercise impairment. Results:The participants achieved 62.9% of the predicted six-minute walk distance (6MWD). 6MWD was strongly correlated with age (r=−0.678, p<0.001), dyspnea before the 6MWT (r=−0.668, p<0.001), and chair stands (r=0.745, p<0.001). A moderate correlation was observed between 6MWD and maximal inspiratory pressure (r=0.532, p=0.002), maximal expiratory pressure (r=0.522, p=0.003), and shoulder flexion (r=0.479, p=0.007). Age and maximal expiratory pressure were identified as independent determinants of exercise capacity, accounting for 57.4% of the variance. Conclusion:Assessing respiratory parameters may have a fundamental role in improving posttransplant outcomes in especially older liver transplant candidates.