Prehabilitation interventions to support the postoperative recovery of adult kidney transplant candidates: a scoping review

Kidney transplantation typically offers superior health outcomes than other renal replacement therapies for people with kidney failure. However, kidney transplant recipients still often experience residual complications of kidney failure, such as frailty, cognitive challenges, and/or anxiety after transplant. Prehabilitation has been proposed to improve post-transplant outcomes, but it is unclear to what extent prehabilitation interventions have been studied to support postoperative recovery in adult kidney transplant candidates (KTC). This scoping review followed the Joanna Briggs Institute methodology. Five electronic databases (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and CINAHL Plus) were searched. All articles reporting on prehabilitation interventions (i.e. preoperative interventions providing exercise, nutritional, cognitive, psychosocial, and/or educational support) for KTCs were included. Title and abstract screening were divided and conducted independently by two researchers after initial inter-rater calibration, then full text screening and data extraction were performed in duplicate. Data analysis was completed using descriptive statistics and narrative synthesis. Nine studies were found to be eligible and included in the review. Prehabilitation interventions described in the literature consisted of psychosocial (n = 3; 33%), physical training (n = 3; 33%), diet/nutrition (n = 1; 11%), educational (n = 1; 11%), and multi-domain (n = 1; 11%) interventions. Interventions were primarily delivered individually in a face-to-face format (n = 4; 44%) or a virtual asynchronous format (n = 2; 22%), and were typically delivered in outpatient clinics (n = 2; 20%). Eight categories of outcomes were assessed across the nine studies, which included cognition-based outcomes (n = 6; 67%), individual outcomes (n = 5; 56%), intervention specific outcomes (n = 4; 44%), and functional and/or performance outcomes (n = 3; 33%). This scoping review highlights a lack of research into prehabilitation interventions for KTC. It suggests a need for further research to support the development of comprehensive prehabilitation protocols for KTC, and more research into their functional impacts.