For patients awaiting a liver transplant, the wait can be as dangerous as the underlying disease. But new research suggests that a structured exercise regimen—often called prehabilitation—can cut the risk of dying before surgery by roughly half.
Published in the journal Clinical Gastroenterology and Hepatology, the study from Northwestern University tracked nearly 1,300 adults evaluated for liver transplantation at the University of Pittsburgh between 2018 and 2022. Of those, 355 participated in a personalized, physician-supervised fitness program. The rest received standard care.
The results were striking: 64% of participants improved their physical function, and those who boosted their scores by at least 0.4 points on a composite measure of grip strength, chair stands, and balance saw about a 50% lower risk of death while on the waitlist.
“It doesn’t matter how severe their disease is,” said Dr. Andres Duarte-Rojo, a transplant hepatologist at Northwestern and lead author of the study. “If they exercise and do what we ask them to do, they see a major improvement in their fitness and reduce their mortality risk before transplantation.”
The program wasn’t about intense workouts. “You don’t send these patients to the gym to lift 100 pounds,” Duarte-Rojo explained. “You have to start low and progress slowly. But we find that the frailest ones often improve the most.” This finding challenges the assumption that the sickest patients are too weak to benefit from exercise.
The research comes amid a growing national conversation about transplant access and outcomes. According to the United Network for Organ Sharing, roughly 100,000 Americans are currently on transplant waiting lists, with average wait times ranging from months to years depending on the organ. For liver patients, the median wait can exceed a year, and frailty is a known predictor of waitlist mortality.
The study’s authors argue that prehabilitation should be integrated into standard transplant care, not treated as an optional extra. “We’re not just improving quality of life,” Duarte-Rojo said. “We’re saving lives.”
While the study focused on liver patients, the findings may have broader implications for other transplant candidates and for maternal health research that examines how pre-existing conditions affect outcomes. The team is now exploring whether similar programs could benefit patients awaiting kidney or heart transplants.
The findings also add to a growing body of evidence linking lifestyle interventions to better surgical outcomes, a topic that has drawn attention in public health debates over how modifiable risk factors influence hospitalizations. For policymakers, the study underscores the potential cost savings of keeping patients healthier while they wait, potentially reducing the need for emergency transplants.
Duarte-Rojo acknowledged that implementation faces hurdles, including funding and patient adherence. But he stressed that the payoff is clear. “This is a low-tech, high-impact intervention,” he said. “We have the tools; we just need to use them.”
