Preliminary Results of the Evaluation of an Integrated Intervention Combining a Digital Platform, an Interdisciplinary Team, and Peer Support for People Listed for Liver Transplantation: A Longitudinal Mixed-Methods Study

Abstract Background Candidates for liver transplantation often present with frailty and functional deconditioning that can compromise their pre-transplant trajectory. The transplant Action Connected program in liver transplantation (TAC-Liver graft) offers an integrated connected prehabilitation intervention combining a digital platform, connected devices, personalized physical activity and nutrition goals, interdisciplinary follow-up, and support from peers who have experienced transplantation. This model aims to support self-management, continuity of follow-up, and functional preparation while awaiting transplantation. Objectives To evaluate, in a mid-study preliminary analysis, an integrated prehabilitation intervention for patients awaiting liver transplantation that combines peer support, a digital platform with connected devices, and interdisciplinary follow-up. Methods A prospective longitudinal mixed-methods study was conducted among 24 pre-transplant participants. Quantitative data included daily step counts, achievement of individualized walking goals, and the Liver Frailty Index (LFI), measured at enrollment and at three months. A classification of step trajectories, established through group-based trajectory modeling among 45 patients, was applied to the 24 participants. Forty-eight interviews conducted at approximately six weeks and three months were thematically analyzed and then integrated with the quantitative data in an individual longitudinal matrix. Results The mean observation period was 141 days (SD = 106.1). Among participants, 17 (70.8%) showed a stable step trajectory, 6 (25.0%) an increasing trajectory, and 1 (4.2%) a decreasing trajectory. Daily step goals were met on average during 74.5% of observed days. Among the 23 participants with two LFI measurements, the mean LFI decreased slightly from 3.64 to 3.54, with both mean values remaining within the pre-frail range. At the individual level, 15 participants (65.2%) had a lower LFI at three months, 1 (4.3%) remained unchanged, and 7 (30.4%) had a higher LFI. Data integration showed that stability in step counts could coexist with functional improvement. Interviews indicated that connected devices supported self-monitoring, routines, motivation, and a sense of security, but their usefulness was limited by technical issues and incomplete measurement of certain activities. The interdisciplinary team played a central role in personalizing and ensuring the safety of goals. Peers mainly provided emotional and experiential support, while family members offered daily and logistical support. Conclusions These preliminary results suggest that connected, interdisciplinary prehabilitation can support the maintenance of activity and potentially favorable changes in functional before liver transplantation. However, step count alone does not fully reflect clinical progress and must be interpreted alongside the LFI and qualitative data.