Perioperative rehabilitation for living-donor liver transplant recipients

Abstract

Perioperative rehabilitation, provided in the form of a protocol for major abdominal and cardiothoracic surgeries, has been reported to reduce the frequency of postoperative pulmonary complications, to promote recovery of postoperative physical activity and to shorten postoperative hospital stay, all of which has also been essential for liver transplant recipients. Living-donor liver transplantation (LDLT), executed as standby surgery, meets the requirements to apply perioperative rehabilitation. In the period of postoperative intensive care, immobilization is directed for a certain number of days, because undesirable deviation of the graft liver is averted while the graft is not fixed, and possible risk of bleeding causedby any motion is an anxious matter after beginning postoperative anticoagulant therapy. In the same period, both respiratory rehabilitation and early ambulation have to be poorly performed, and therefore, another intervention should be flexibly considered. In both the stage out from intensive care and the stage of post-discharge, the patients can operate almost independently in their fundamental daily activities, but some articles reported that many of them experienced low physical endurance for social activities including return to employment. Sustained low endurance after LDLT may present for mixed causes. Further pursuit of a possible resolution of such a condition is needed in our field for improving the QOL of the recipients.