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February 2026 LIVER TRANSPLANT PREHABILITATION PROGRAM HELPS PATIENTS GET TRANSPLANT-READYTransplant Hepatologist Andres Duarte-Rojo, MD, and Susanna Miranda, DNP, APRN, are leading Northwestern Medicine's efforts to reduce frailty and enhance survival of patients who are preparing for liver transplantation. A multidisciplinary team that includes an exercise physiologist, a physical therapist and a dietitian assesses each patient and personalizes their at-home program.
Approximately half of the program's patients have been deemed candidates for liver transplant by a Northwestern Medicine hepatologist, whereas the other half of the patients are in the evaluation phase of the transplant process and not yet on the waitlist. It is through this program that they can successfully move toward waitlisting and/or transplantation, while reducing hospital admissions and post-transplant complications. Assessing and reducing frailty Dr. Duarte-Rojo's previous studies demonstrated the feasibility of prehabilitation in improving both the liver frailty index and the six-minute walk test, particularly in adherent patients. By improving these measures, patients experienced a survival advantage for surgery. "We tell patients this isn't an exercise program to get you into your favorite outfit; it's exercise because your life depends on it," Dr. Duarte-Rojo says. "We see each patient's potential for success." After an evaluation in the team's Chicago clinic, patients follow their plans at home for two to six weeks before returning to the clinic for a reevaluation. This program structure eliminates the transportation challenge many patients face for outpatient rehabilitation appointments. Promoting patient progress Many of the patients who undergo prehabilitation are excited to demonstrate their progress when they return to the clinic. They often talk about how they were able to enhance their diets and at-home movement, even if they walked for five minutes every hour. "It's exciting to see some of these frail patients go from having so many obstacles and barriers because of their health condition, to attaining their goals and achieving the objective, which is transplant surgery," she says. Miranda says she came to work at Northwestern Medicine to be part of the prehabilitation program because she could see the positive effect it has on patients' lives. "The most rewarding part of this program is when I get to see our patients after transplant surgery," Miranda says. "Last week a patient told me she couldn't go to Shirley Ryan AbilityLab for recovery after her surgery because she was too strong. She was discharged home, and to see her smiling and proud was amazing." This article was originally published in the Northwestern Medicine Physician Forum on February 19, 2026. |
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