February 2026

ORGAN TRANSPLANT

LIVER TRANSPLANT PREHABILITATION PROGRAM PREPARES PATIENTS FOR BETTER OUTCOMES

Featuring:  Andres Duarte-Rojo, MD, and Susanna Miranda, DNP, APRN
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Frailty affects up to 43% of patients with end-stage liver disease (ESLD) and is strongly associated with post-liver-transplant mortality. However, national guidelines discourage using it as the only reason to decline a patient for liver transplantation, as some frail patients have acceptable outcomes. 

Transplant Hepatologist Andres Duarte-Rojo, MD, and Susanna Miranda, DNP, APRN, are leading Northwestern Medicine Organ Transplant Center's efforts to reduce frailty and enhance survival of patients who are preparing for liver transplantation.
The center created a specialized program with a multidisciplinary team that includes an exercise physiologist, a physical therapist and a dietitian. The team assesses each patient and personalizes their at-home “prehab.” The program aims to help the patients move toward waitlisting and/or transplantation, while reducing hospital admissions and post-transplant complications. 
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Approximately half of the program's patients have been deemed candidates for liver transplant by a Northwestern Medicine hepatologist. The rest are in the evaluation phase 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, patients follow their plans at home for two to six weeks before returning to the clinic for a reevaluation. This structure eliminates the transportation challenge many patients face for outpatient rehabilitation appointments.

Susanna Miranda, DNP, APRN 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. "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.
Andres Duarte-Rojo, MD, ​the section chief of of Hepatology and director of Liver Transplant at Northwestern Medicine.
Susanna Miranda, DNP, APRN

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