Prehabilitation prior to kidney transplantation: Results from a pilot study

Abstract

Prehabilitation is the process of enhancing pre-operative functional capacity to improve tolerance for the upcoming stressor; it was associated with improved post-operative outcomes in a handful of studies, but never evaluated in transplantation. Kidney transplant (KT) candidates may be uniquely suited for prehabilitation because they experience a profound loss of functional capacity while waiting years on dialysis. To better understand the feasibility and effectiveness of prehabilitation in KT, we conducted a pilot study of center-based prehabilitation for candidates; this intervention consisted of weekly physical therapy sessions at an outpatient center with at home exercises. We enrolled 24 participants; 18 participated in prehabilitation (75% of enrolled; 17% of eligible). 61% were male, 72% were African American, and mean age=52 (SD=12.9); 71% of participants had lower extremity impairment and 31% were frail. By 2 months of prehabilitation, participants improved their physical activity by 64% (p=0.004) based on accelerometry. Participants reported high satisfaction. Among 5 prehabilitation participants who received KT during the study, length of stay was shorter than for age, sex, and race-matched control (5 vs. 10 days; RR=0.69; 95%CI:0.50–0.94;P=0.02). These pilot study findings suggest that prehabilitation is feasible in pre-transplant patients and may potentially be a strategy to improve post-KT outcomes.

Physical Performance Testing in Kidney Transplant Candidates at the Top of the Waitlist

“…Median 6MWT results were 305 (IQR, 183-367) m for patients who died, 244 (IQR, 122-328) m for patients removed from the waitlist, 419 (IQR, 370-472) m for transplant recipients, and 403 (IQR, 335-469) m for patients alive on the waitlist with survival time censored. Median STS test results were 14 (IQR, 9-19) repetitions for patients who died, 10 (IQR, 0-15) repetitions for patients removed from the waitlist, 20 (IQR, [16][17][18][19][20][21][22][23] repetitions for transplant recipients, and 18 (IQR, 13-21) repetitions for patients alive on the waitlist with survival time censored.…”

Prevalence of frailty among kidney transplant candidates and recipients in the United States: Estimates from a National Registry and Multicenter Cohort Study

“…Given the high prevalence of frailty, transplant programs should consider assessing frailty during KT evaluation to improve informed consent and identify candidates for pre‐KT interventions. Our findings can encourage centers to include frailty as part of their evaluation and help identify a vulnerable population of patients that may benefit from potential interventions like prehabilitation …”

Frailty Prevalence in Younger End-Stage Kidney Disease Patients Undergoing Dialysis and Transplantation

“…Findings emphasize that frailty screening should not be limited to older ESKD patients but rather should be implemented across all age groups. Additionally, screening should take place earlier among ESKD patients initiating HD and at evaluation for KT to identify patients who would benefit most from pre-KT interventions like prehabilitation [49].…”