Inpatient functional rehabilitation after liver transplantation: clinical benefit for functional recovery and indicators for early intervention – a retrospective observational study

Sarcopenia and frailty are common in liver transplant candidates and often deteriorate early posttransplantation, negatively affecting recovery and survival. Since 5 years, we refer liver transplant recipients who, despite being medically stable, are considered unfit for safe discharge home because of physical, social, or functional limitations for continued care at an independent rehabilitation hospital. This retrospective observational study evaluated safety and functional outcomes of this rehabilitation program and explored clinical characteristics associated with referral. We reviewed all adult liver transplant recipients at University Hospitals Leuven between July 2020 and 2025. Collected data included demographics, frailty, BMI, neuropathy, laboratory model for end-stage liver disease/Stanford Integrated Psychosocial Assessment for Transplant scores, ICU/hospital length of stay, and referral for inpatient rehabilitation. For referred patients, rehabilitation duration and functional outcomes were analyzed. Of 380 liver transplant recipients, 34 (8.9%) were referred for inpatient rehabilitation. Median rehabilitation duration was 30 days [interquartile range (IQR): 21-40]. Significant functional improvements were observed, with 6-min walk distance increasing from 130 (IQR: 33-225) to 300 (IQR: 220-423; P ≤ 0.001) m, and Tinetti scores improving from 21 (IQR: 18-23) to 25 (IQR: 22-27; P = 0.001). No mortality occurred during rehabilitation. Four patients were readmitted for reasons unrelated to rehabilitation. Multivariable logistic regression identified lower pretransplant BMI and higher frailty scores as independent predictors of referral, with a trend toward an association with peroneal neuropathy. Continued inpatient rehabilitation following liver transplant is feasible, safe, and associated with clinically relevant functional improvements. Pretransplant malnutrition and frailty, as well as posttransplant peroneal neuropathy, may represent targets to facilitate posttransplant recovery.