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.

Associazione Italiana Ipertensione Polmonare Bologna Italy

Centre for Nephrology Urology and Transplantation Faculty of Life Sciences and Medicine King's College London London United Kingdom

Clinical and Experimental Endocrinology Department of Chronic Diseases and Metabolism KU Leuven Leuven Belgium

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Endocrinology University Hospitals Leuven Leuven Belgium

Department of General Visceral and Transplant Surgery Hospital Clínico y Universitario Virgen de La Arrixaca Murcia Spain

Department of Nephrology Transplantology and Internal Medicine Medical University of Gdańsk Gdańsk Poland

Department of Public Health and Primary Care Academic Centre for Nursing and Midwifery KU Leuven Leuven Belgium

Diabetes Center Institute for Clinical and Experimental Medicine Prague Czechia

Group Rehabilitation for Internal Disorders Department of Rehabilitation Sciences KU Leuven Leuven Belgium

Kidney Transplant Program Hospital del Mar Barcelona Spain

Laboratory of Abdominal Transplantation Department of Microbiology Immunology and Transplantation KU Leuven Leuven Belgium

Laboratory of Sports Medicine Department of Physical Education and Sports Science Aristotle University of Thessaloniki Thessaloniki Greece

Liver Transplant Center University Hospital Center Zagreb School of Medicine University of Zagreb Zagreb Croatia

Nephrology and Renal Transplantation Department of Microbiology Immunology and Transplantation KU Leuven Leuven Belgium

Physiotherapy Department of Health Sciences College of Health Medicine and Life Sciences Brunel University London London United Kingdom

Renal Medicine and Therapies King's College Hospital NHS Trust London United Kingdom

Representative of the European Kidney Patients' Federation Dublin Ireland

Respiratory Epidemiology and Clinical Research Unit Centre for Outcomes Research and Evaluation Research Institute of McGill University Health Centre Montreal QC Canada

School of Physical and Occupational Therapy McGill University Montreal QC Canada

School of Rehabilitation Therapy Queen's University Kingston ON Canada

Section of Hepatobiliary Surgery and Liver Transplantation Department of Surgery University Medical Center Groningen University of Groningen Groningen Netherlands

Section of Lung Transplantation Department of Cardiology Rigshospitalet Copenhagen Denmark

Section of Nursing Science Department of Health Sciences University Medical Center Groningen University of Groningen Groningen Netherlands

Transplantoux Foundation Leuven Belgium

Ukrainian Transplant Coordination Center Specialized State Institution Kiev Ukraine

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Davison SN, Levin A, Moss AH, Jha V, Brown EA, Brennan F, et al. Executive Summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: Developing a Roadmap to Improving Quality Care. Kidney Int (2015) 88(3):447–59. 10.1038/ki.2015.110 PubMed DOI

Kilic A, Acker MA, Atluri P. Dealing With Surgical Left Ventricular Assist Device Complications. J Thorac Dis (2015) 7(12):2158–64. 10.3978/j.issn.2072-1439.2015.10.64 PubMed DOI PMC

Rocker G. Harms of Overoxygenation in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease. CMAJ (2017) 189(22):E762–E763. 10.1503/cmaj.170196 PubMed DOI PMC

Minnella EM, Carli F. Prehabilitation and Functional Recovery for Colorectal Cancer Patients. Ejso-eur J Surg Onc (2018) 44(7):919–26. 10.1016/j.ejso.2018.04.016 PubMed DOI

Carli F, Scheede-Bergdahl C. Prehabilitation to Enhance Perioperative Care. Anesthesiol Clin (2015) 33(1):17–33. 10.1016/j.anclin.2014.11.002 PubMed DOI

Heger P, Probst P, Wiskemann J, Steindorf K, Diener MK, Mihaljevic AL. A Systematic Review and Meta-Analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366). J Gastrointest Surg (2020) 24(6):1375–85. 10.1007/s11605-019-04287-w PubMed DOI

Moyer R, Ikert K, Long K, Marsh J. The Value of Preoperative Exercise and Education for Patients Undergoing Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev (2017) 5(12):e2. 10.2106/JBJS.RVW.17.00015 PubMed DOI

Waterland JL, McCourt O, Edbrooke L, Granger CL, Ismail H, Riedel B, et al. Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis. Front Surg (2021) 8:628848. 10.3389/fsurg.2021.628848 PubMed DOI PMC

Lambert JE, Hayes LD, Keegan TJ, Subar DA, Gaffney CJ. The Impact of Prehabilitation on Patient Outcomes in Hepatobiliary, Colorectal, and Upper Gastrointestinal Cancer Surgery: A PRISMA-Accordant Meta-Analysis. Ann Surg (2021) 274(1):70–7. 10.1097/SLA.0000000000004527 PubMed DOI

van Wijk L, Bongers BC, Berkel AEM, Buis CI, Reudink M, Liem MSL, et al. Improved Preoperative Aerobic Fitness Following a Home-Based Bimodal Prehabilitation Programme in High-Risk Patients Scheduled for Liver or Pancreatic Resection. Br J Surg (2022) 109(11):1036–9. 10.1093/bjs/znac230 PubMed DOI PMC

Wallen MP, Skinner TL, Pavey TG, Hall A, Macdonald GA, Coombes JS. Safety, Adherence and Efficacy of Exercise Training in Solid-Organ Transplant Candidates: A Systematic Review. Transplant Rev (2016) 30(4):218–26. 10.1016/j.trre.2016.07.004 PubMed DOI

Pesce de Souza F, Massierer D, Anand Raje U, Tansey CM, Boruff J, Janaudis-Ferreira T. Exercise Interventions in Solid Organ Transplant Candidates: A Systematic Review. Clin Transplant (2020) 34(9):e13900. 10.1111/ctr.13900 PubMed DOI

Janaudis-Ferreira T, Mathur S, Deliva R, Howes N, Patterson C, Rakel A, et al. Exercise for Solid Organ Transplant Candidates and Recipients: A Joint Position Statement of the Canadian Society of Transplantation and CAN-RESTORE. Transplantation (2019) 103(9):e220–e238. 10.1097/TP.0000000000002806 PubMed DOI

Cillo U, Weissenbacher A, Pengel L, Jochmans I, Roppolo D, Amarelli C, et al. ESOT Consensus Platform for Organ Transplantation: Setting the Stage for a Rigorous, Regularly Updated Development Process. Transpl Int (2022) 35:10915. 10.3389/ti.2022.10915 PubMed DOI PMC

Davies KS. Formulating the Evidence Based Practice Question: A Review of the Frameworks. Evid Based Libr Inf Pract (2011) 6(2):75–80. 10.18438/b8ws5n DOI

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations. Br Med J (2008) 336(7650):924–6. 10.1136/bmj.39489.470347.AD PubMed DOI PMC

DMDIAf. investopedia.com/terms/d/delphi-method.asp (2023). Available From: https://www.investopedia.com/terms/d/delphi-method.asp (Accessed May 11th, 2023).

Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. The Global Rating Scale Complements the AGREE II in Advancing the Quality of Practice Guidelines. J Clin Epidemiol (2012) 65(5):526–34. 10.1016/j.jclinepi.2011.10.008 PubMed DOI

Laoutaris ID, Dritsas A, Adamopoulos S, Manginas A, Gouziouta A, Kallistratos MS, et al. Benefits of Physical Training on Exercise Capacity, Inspiratory Muscle Function, and Quality of Life in Patients With Ventricular Assist Devices Long-Term Postimplantation. Eur J Cardiovasc Prev Rehabil (2011) 18(1):33–40. 10.1097/HJR.0b013e32833c0320 PubMed DOI

Gloeckl R, Halle M, Kenn K. Interval Versus Continuous Training in Lung Transplant Candidates: A Randomized Trial. J Heart Lung Transplant (2012) 31(9):934–41. 10.1016/j.healun.2012.06.004 PubMed DOI

Hayes K, Leet AS, Bradley SJ, Holland AE. Effects of Exercise Training on Exercise Capacity and Quality of Life in Patients With a Left Ventricular Assist Device: A Preliminary Randomized Controlled Trial. J Heart Lung Transplant (2012) 31(7):729–34. 10.1016/j.healun.2012.02.021 PubMed DOI

Adamopoulos S, Gouziouta A, Mantzouratou P, Laoutaris ID, Dritsas A, Cokkinos DV, et al. Thyroid Hormone Signalling Is Altered in Response to Physical Training in Patients With End-Stage Heart Failure and Mechanical Assist Devices: Potential Physiological Consequences? Interactive Cardiovasc Thorac Surg (2013) 17(4):664–8. 10.1093/icvts/ivt294 PubMed DOI PMC

Limongi V, Dos Santos DC, da Silva AMO, Ataide EC, Mei MFT, Udo EY, et al. Effects of a Respiratory Physiotherapeutic Program in Liver Transplantation Candidates. Transpl Proc (2014) 46(6):1775–7. 10.1016/j.transproceed.2014.05.044 PubMed DOI

Forestieri P, Guizilini S, Peres M, Bublitz C, Bolzan DW, Rocco IS, et al. A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: A Pilot Study. Braz J Cardiovasc Surg (2016) 31(5):389–95. 10.5935/1678-9741.20160078 PubMed DOI PMC

Pehlivan E, Mutluay F, Balci A, Kilic L. The Effects of Inspiratory Muscle Training on Exercise Capacity, Dyspnea and Respiratory Functions in Lung Transplantation Candidates: A Randomized Controlled Trial. Clin Rehabil (2018) 32(10):1328–39. 10.1177/0269215518777560 PubMed DOI

Grat M, Wronka KM, Lewandowski Z, Grat K, Krasnodebski M, Stypulkowski J, et al. Effects of Continuous Use of Probiotics Before Liver Transplantation: A Randomized, Double-Blind, Placebo-Controlled Trial. Clin Nutr (2017) 36(6):1530–9. 10.1016/j.clnu.2017.04.021 PubMed DOI

Plank LD, Mathur S, Gane EJ, Peng SL, Gillanders LK, McIlroy K, et al. Perioperative Immunonutrition in Patients Undergoing Liver Transplantation: A Randomized Double-Blind Trial. Hepatology (2015) 61(2):639–47. 10.1002/hep.27433 PubMed DOI

Eguchi S, Takatsuki M, Hidaka M, Soyama A, Ichikawa T, Kanematsu T. Perioperative Synbiotic Treatment to Prevent Infectious Complications in Patients After Elective Living Donor Liver Transplantation: A Prospective Randomized Study. Am J Surg (2011) 201(4):498–502. 10.1016/j.amjsurg.2010.02.013 PubMed DOI

Forli L, Pedersen JI, Bjortuft O, Vatn M, Boe J. Dietary Support to Underweight Patients With End-Stage Pulmonary Disease Assessed for Lung Transplantation. Respiration (2001) 68(1):51–7. 10.1159/000050463 PubMed DOI

Forli L, Bjortuft O, Vatn M, Kofstad J, Boe J. A Study of Intensified Dietary Support in Underweight Candidates for Lung Transplantation. Ann Nutr Metab (2001) 45(4):159–68. 10.1159/000046724 PubMed DOI

Le Cornu KA, McKiernan FJ, Kapadia SA, Neuberger JM. A Prospective Randomized Study of Preoperative Nutritional Supplementation in Patients Awaiting Elective Orthotopic Liver Transplantation. Transplantation (2000) 69(7):1364–9. 10.1097/00007890-200004150-00026 PubMed DOI

Park TL, Perri MG, Rodrigue JR. Minimal Intervention Programs for Weight Loss in Heart Transplant Candidates: A Preliminary Examination. Prog Transpl (2003) 13(4):284–8. 10.1177/152692480301300408 PubMed DOI

Napolitano MA, Babyak MA, Palmer S, Tapson V, Davis RD, Blumenthal JA, et al. Effects of a Telephone-Based Psychosocial Intervention for Patients Awaiting Lung Transplantation. Chest (2002) 122(4):1176–84. 10.1378/chest.122.4.1176 PubMed DOI

Rodrigue JR, Baz MA, Widows MR, Ehlers SL. A Randomized Evaluation of Quality-Of-Life Therapy With Patients Awaiting Lung Transplantation. Am J Transplant (2005) 5(10):2425–32. 10.1111/j.1600-6143.2005.01038.x PubMed DOI

Sharif F, Mohebbi S, Tabatabaee HR, Saberi-Firoozi M, Gholamzadeh S. Effects of Psycho-Educational Intervention on Health-Related Quality of Life (QOL) of Patients With Chronic Liver Disease Referring to Shiraz University of Medical Sciences. Health Qual Life Outcomes (2005) 3:81. 10.1186/1477-7525-3-81 PubMed DOI PMC

Blumenthal JA, Babyak MA, Keefe FJ, Davis RD, Lacaille RA, Carney RM, et al. Telephone-Based Coping Skills Training for Patients Awaiting Lung Transplantation. J Consult Clin Psychol (2006) 74(3):535–44. 10.1037/0022-006X.74.3.535 PubMed DOI

Rodrigue JR, Mandelbrot DA, Pavlakis M. A Psychological Intervention to Improve Quality of Life and Reduce Psychological Distress in Adults Awaiting Kidney Transplantation. Nephrol Dial Transplant (2011) 26(2):709–15. 10.1093/ndt/gfq382 PubMed DOI PMC

Gross CR, Reilly-Spong M, Park T, Zhao R, Gurvich OV, Ibrahim HN. Telephone-Adapted Mindfulness-Based Stress Reduction (tMBSR) for Patients Awaiting Kidney Transplantation. Contemp Clin Trials (2017) 57:37–43. 10.1016/j.cct.2017.03.014 PubMed DOI PMC

Ben-Gal T, Pinchas A, Zafrir N, Sahar G, Berman M, Aravot D. Long-Term Physical Training in Cardiac Transplant Candidates: Is it Feasible? Transpl Proc (2000) 32(4):740–2. 10.1016/s0041-1345(00)00964-7 PubMed DOI

Karapolat H, Engin C, Eroglu M, Yagdi T, Zoghi M, Nalbantgil S, et al. Efficacy of the Cardiac Rehabilitation Program in Patients With End-Stage Heart Failure, Heart Transplant Patients, and Left Ventricular Assist Device Recipients. Transpl Proc (2013) 45(9):3381–5. 10.1016/j.transproceed.2013.06.009 PubMed DOI

Florian J, Rubin A, Mattiello R, Fontoura FF, Camargo Jde J, Teixeira PJ. Impact of Pulmonary Rehabilitation on Quality of Life and Functional Capacity in Patients on Waiting Lists for Lung Transplantation. J Bras Pneumol (2013) 39(3):349–56. 10.1590/S1806-37132013000300012 PubMed DOI PMC

Li M, Mathur S, Chowdhury NA, Helm D, Singer LG. Pulmonary Rehabilitation in Lung Transplant Candidates. J Heart Lung Transpl (2013) 32(6):626–32. 10.1016/j.healun.2013.04.002 PubMed DOI

Debette-Gratien M, Tabouret T, Antonini MT, Dalmay F, Carrier P, Legros R, et al. Personalized Adapted Physical Activity Before Liver Transplantation: Acceptability and Results. Transplantation (2015) 99(1):145–50. 10.1097/TP.0000000000000245 PubMed DOI

Kenn K, Gloeckl R, Soennichsen A, Sczepanski B, Winterkamp S, Boensch M, et al. Predictors of Success for Pulmonary Rehabilitation in Patients Awaiting Lung Transplantation. Transplantation (2015) 99(5):1072–7. 10.1097/TP.0000000000000472 PubMed DOI

Pehlivan E, Balci A, Kilic L, Kadakal F. Preoperative Pulmonary Rehabilitation for Lung Transplant: Effects on Pulmonary Function, Exercise Capacity, and Quality of Life; First Results in Turkey. Exp Clin Transplant (2018) 16(4):455–60. 10.6002/ect.2017.0042 PubMed DOI

da Fontoura FF, Berton DC, Watte G, Florian J, Schio SM, Camargo JDP, et al. Pulmonary Rehabilitation in Patients With Advanced Idiopathic Pulmonary Fibrosis Referred for Lung Transplantation. J Cardiopulmonary Rehabil Prev (2018) 38(2):131–4. 10.1097/HCR.0000000000000315 PubMed DOI

Ochman M, Maruszewski M, Latos M, Jastrzebski D, Wojarski J, Karolak W, et al. Nordic Walking in Pulmonary Rehabilitation of Patients Referred for Lung Transplantation. Transpl Proc (2018) 50(7):2059–63. 10.1016/j.transproceed.2018.02.106 PubMed DOI

Byrd R, Smith P, Mohamedaly O, Snyder LD, Pastva AM. A 1-Month Physical Therapy-Based Outpatient Program for Adults Awaiting Lung Transplantation: A Retrospective Analysis of Exercise Capacity, Symptoms, and Quality of Life. Cardiopulmonary Phys Ther J (2019) 30(2):61–9. 10.1097/CPT.0000000000000087 PubMed DOI PMC

Florian J, Watte G, Teixeira PJZ, Altmayer S, Schio SM, Sanchez LB, et al. Pulmonary Rehabilitation Improves Survival in Patients With Idiopathic Pulmonary Fibrosis Undergoing Lung Transplantation. Sci Rep (2019) 9:9347. 10.1038/s41598-019-45828-2 PubMed DOI PMC

McAdams-DeMarco MA, Ying H, Van Pilsum Rasmussen S, Schrack J, Haugen CE, Chu NM, et al. Prehabilitation Prior to Kidney Transplantation: Results From a Pilot Study. Clin Transplant (2019) 33(1):e13450. 10.1111/ctr.13450 PubMed DOI PMC

Kilic L, Pehlivan E, Balci A, Bakan ND. Effect of 8-week Pulmonary Rehabilitation Program on Dyspnea and Functional Capacity of Patients on Waiting List for Lung Transplantation. Turkish Thorac J (2020) 21(2):110–5. 10.5152/TurkThoracJ.2019.18202 PubMed DOI PMC

Pehlivan E, Balci A, Kilic L. The Effect of Pulmonary Rehabilitation on Dyspnea and Factors Related to Dyspnea in Lung Transplantation Candidates. Eur Res J (2020) 6(5):395–400. 10.18621/eurj.531507 DOI

Lorenz EC, Hickson LJ, Weatherly RM, Thompson KL, Walker HA, Rasmussen JM, et al. Protocolized Exercise Improves Frailty Parameters and Lower Extremity Impairment: A Promising Prehabilitation Strategy for Kidney Transplant Candidates. Clin Transpl (2020) 34(9):e14017. 10.1111/ctr.14017 PubMed DOI PMC

Massierer D, Bourgeois N, Rakel A, Prevost K, Lands LC, Poirier C, et al. Changes in 6-minute Walking Distance in Lung Transplant Candidates While Participating in a Home-Based Pre-Habilitation Program-A Retrospective Chart Review. Clin Transplant (2020) 34(10):e14045. 10.1111/ctr.14045 PubMed DOI

Wickerson L, Rozenberg D, Helm D, Gottesman C, Mathur S, Singer LG. Short Physical Performance Battery Scores at Lung Transplant Assessment: Relationship to Early Transplant Outcomes and Response to Pre-habilitation. J Heart Lung Transplant (2020) 39:S208–9. 10.1016/j.healun.2020.01.828 PubMed DOI

Lin FP, Visina JM, Bloomer PM, Dunn MA, Josbeno DA, Zhang X, et al. Prehabilitation-Driven Changes in Frailty Metrics Predict Mortality in Patients With Advanced Liver Disease. Am J Gastroenterol (2021) 116(10):2105–17. 10.14309/ajg.0000000000001376 PubMed DOI

Kerti M, Bohacs A, Madurka I, Kovats Z, Gieszer B, Elek J, et al. The Effectiveness of Pulmonary Rehabilitation in Connection With Lung Transplantation in Hungary. Ann (2021) 10(4):3906–15. 10.21037/apm-20-1783 PubMed DOI

Layton AM, Irwin AM, Mihalik EC, Fleisch E, Keating CL, Dimango EA, et al. Telerehabilitation Using Fitness Application in Patients With Severe Cystic Fibrosis Awaiting Lung Transplant: A Pilot Study. Int J Telemed Appl (2021) 2021:6641853. 10.1155/2021/6641853 PubMed DOI PMC

Wickerson L, Helm D, Gottesman C, Rozenberg D, Singer LG, Keshavjee S, et al. Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation. JMIR MHealth and UHealth (2021) 9(6):e28708. 10.2196/28708 PubMed DOI PMC

Duarte-Rojo A, Bloomer PM, Rogers RJ, Hassan MA, Dunn MA, Tevar AD, et al. Introducing EL-FIT (Exercise and Liver FITness): A Smartphone App to Prehabilitate and Monitor Liver Transplant Candidates. Liver Transplant (2021) 27(4):502–12. 10.1002/lt.25950 PubMed DOI PMC

Byrd R, Vallabhajosula S, Bailey S, Champion T. Effects of Rehabilitation Before Lung Transplantation on Balance. Cardiopulmonary Phys Ther J (2022) 33(2):50–9. 10.1097/cpt.0000000000000187 DOI

Singer JP, Soong A, Bruun A, Bracha A, Chin G, Hays SR, et al. A Mobile Health Technology Enabled Home-Based Intervention to Treat Frailty in Adult Lung Transplant Candidates: A Pilot Study. Clin Transplant (2018) 32(6):e13274. 10.1111/ctr.13274 PubMed DOI PMC

Anderson MR, Easthausen I, Gallagher G, Udupa J, Tong Y, Torigian D, et al. Skeletal Muscle Adiposity and Outcomes in Candidates for Lung Transplantation: A Lung Transplant Body Composition Cohort Study. Am J Respir Crit Care Med Conf Am Thorac Soc Int Conf ATS. (2020) 201(1):A2827. 10.1164/ajrccm-conference.2020.201.1_MeetingAbstracts.A2827 PubMed DOI PMC

Morkane CM, Kearney O, Bruce DA, Melikian CN, Martin DS. An Outpatient Hospital-Based Exercise Training Program for Patients With Cirrhotic Liver Disease Awaiting Transplantation: A Feasibility Trial. Transplantation (2020) 104(1):97–103. 10.1097/TP.0000000000002803 PubMed DOI

Craig JA, Miner D, Remtulla T, Miller J, Zanussi LW. Piloting a Coping Skills Group Intervention to Reduce Depression and Anxiety Symptoms in Patients Awaiting Kidney or Liver Transplant. Health Soc Work (2017) 42(1):e44–e52. 10.1093/hsw/hlw064 PubMed DOI

Febrero B, Ramirez P, Martinez-Alarcon L, Abete C, Galera M, Rios A, et al. Group Psychotherapy Could Improve Depression in Cirrhotic Patients on the Liver Transplant Waiting List. Transpl Proc (2019) 51(1):28–32. 10.1016/j.transproceed.2018.02.206 PubMed DOI

Jutagir DR, Saracino RM, Cunningham A, Foran-Tuller KA, Driscoll MA, Sledge WH, et al. The Feasibility of a Group Stress Management Liver SMART Intervention for Patients With End-Stage Liver Disease: A Pilot Study. Palliat Support Care (2019) 17(1):35–41. 10.1017/S147895151800024X PubMed DOI PMC

Zhao Q, Zhang S, Yu R. Impact of Pre-Transplantation Psychological Counseling in Improving the Mental Well-Being of Patients on Hemodialysis. Front Psychiatr (2021) 12:594670. 10.3389/fpsyt.2021.594670 PubMed DOI PMC

Zamora-Valdes D, Watt KD, Kellogg TA, Poterucha JJ, Di Cecco SR, Francisco-Ziller NM, et al. Long-Term Outcomes of Patients Undergoing Simultaneous Liver Transplantation and Sleeve Gastrectomy. Hepatology (2018) 68(2):485–95. 10.1002/hep.29848 PubMed DOI

Hollander FM, van Pierre DD, de Roos NM, van de Graaf EA, Iestra JA. Effects of Nutritional Status and Dietetic Interventions on Survival in Cystic Fibrosis Patients Before and After Lung Transplantation. J Cyst Fibros (2014) 13(2):212–8. 10.1016/j.jcf.2013.08.009 PubMed DOI

Ju A, Cazzolli R, Howell M, Scholes-Robertson N, Wong G, Jaure A. Novel Endpoints in Solid Organ Transplantation: Targeting Patient-Reported Outcome Measures. Transplantation (2023). Publish Ahead of Print. 10.1097/TP.0000000000004537 PubMed DOI

Pearson N, Naylor PJ, Ashe MC, Fernandez M, Yoong SL, Wolfenden L. Guidance for Conducting Feasibility and Pilot Studies for Implementation Trials. Pilot Feasibility Stud (2020) 6(1):167. 10.1186/s40814-020-00634-w PubMed DOI PMC

Perez-Saez MJ, Morgado-Perez A, Faura A, Munoz-Redondo E, Garriz M, Muns MD, et al. The FRAILMar Study Protocol: Frailty in Patients With Advanced Chronic Kidney Disease Awaiting Kidney Transplantation. A Randomized Clinical Trial of Multimodal Prehabilitation. Front Med (2021) 8:675049. 10.3389/fmed.2021.675049 PubMed DOI PMC