Multimodal Inpatient Prehabilitation Prior to Heart or Lung Transplantation in a Latin American Transplant Reference Center

Abstract

Introduction: Whether the implementation of a multimodal prehabilitation program is effective and safe for high-risk heart or lung transplantation candidates, whose condition prevents hospital discharge, is unclear.

Methods: We conducted a retrospective study at a cardiothoracic transplant center in Chile. Two cohorts of hospitalized patients listed for heart or lung transplant were studied: the first underwent traditional (historical) and nonstructured prehabilitation, and the second underwent protocol-driven multimodal prehabilitation (MP). Adverse events and preoperative functional changes in the MP group were documented, as well as comparative postoperative outcomes between both cohorts.

Results: Between 2018 and 2023, 24 transplant recipients were analyzed. During the MP phase, significant improvement was observed in Medical Research Council scale (52.0 ± 7 to 58.7 ± 3; P = .042), sit-to-stand test (7.1 ± 7 to 15.9 ± 6; P = .018), and euthymic state (from 4 to 10 patients; P .036), without reported adverse events. Postoperatively, MP group demonstrated faster standing (1.9 ± 0.7 vs 1.3 ± 0.5 days; P = .05) and sitting times (2.0 ± 0.7 vs 1.2 ± 0.5 days; P = .007), with more early extubations (3 vs 11; P = .003) in comparison to the historical prehabilitation cohort.

Conclusion: In this small retrospective study, MP in hospitalized patients awaiting heart or lung transplantation appears to be safe and associated with improvements in pre- and postoperative outcomes.