This study will assess the feasibility, safety and effectiveness of a structured prehabilitation program combining exercise training, nutritional optimization and psychological support for patients with cirrhosis awaiting liver transplantation.

Due to their chronic liver disease, patients with cirrhosis awaiting liver transplantation develop low muscle mass, poor nutritional status and decreased reserves putting them at high risk of postoperative complications, prolonged hospital stay, and failed discharge home after liver transplantation. Prehabilitation aims to optimize a patient before they undergo a major surgery. These programs combine exercise training, with nutritional optimization and psychological support. Together, these contribute to improve their muscle mass, tolerance to exercise, and nutritional status. The current study will assess whether an individualized and structured prehabilitation program combining supervised exercise training, nutritional optimization and psychological support will benefit patients with cirrhosis awaiting liver transplantation.

Inclusion Criteria:

• Age above 18 years
• Diagnosis of cirrhosis, based on a combination of clinical, laboratory, imaging, or histology
• Active on the liver transplant waiting list of the MUHC

Exclusion Criteria:

• Biological Model for End Stage Liver Disease >20
• Hepatic decompensation within the last month
• High risk varices not on primary or secondary prevention
• Recurrent large volume paracentesis
• Persistent hepatic encephalopathy
• Platelets <20,000/µL, or hemoglobin <80g/L
• Altered hemodynamics
• Significant heart disease
• Awaiting combined organ transplantation
• Awaiting repeat liver transplantation
• Condition limiting mobilization and/or exercise, or recurrent falls