Prehabilitation in Solid Organ Transplant Candidates: A Systematic Review and Meta-analysis

ABSTRACT: Solid organ transplant (SOT) candidates often experience functional decline during waiting times. Prehabilitation has shown benefits in other high-risk surgeries, but limited data are available for SOT. This study evaluated the effectiveness of prehabilitation on outcomes in transplant candidates. Four electronic databases were systematically searched (up to November 2025) that investigated the effects of prehabilitation in patients awaiting SOT. Two reviewers independently conducted the search and screened all records. Methodological quality and therapeutic quality were assessed using the Cochrane Risk of Bias tool and the i-CONTENT tool. A random-effects meta-analysis was performed for all outcomes with 2 or more studies. Thirteen studies (randomized controlled trial, non-randomized controlled trial, and cohort studies) comprising 956 patients were included. Meta-analyses showed that prehabilitation was associated with a shorter hospital length of stay (Mean Difference [MD] -7; 95% confidence interval [CI], -13.7 to -0.3) and improved 6-min walk distance (MD 55.64; 95% CI, 9.61-101.67), but had no significant effects on postoperative complications, handgrip strength (MD -0.47; 95% CI, -3.51 to 2.58), or health-related quality of life (standard mean difference 0.05; 95% CI, -0.39 to 0.50). The certainty of evidence ranged from very low to moderate across all outcomes. According to the i-CONTENT assessment, approximately 45% of the included studies were rated at high risk of ineffectiveness, mainly because of insufficient reporting of exercise dosage, inappropriate outcome assessment methods, and low adherence. Although the risk of ineffectiveness was high for prehabilitation exercise programs and the certainty of evidence was very low to moderate, prehabilitation seems to reduce length of stay and improve functional capacity in patients awaiting SOT.