For people with cirrhosis and advanced liver disease, a liver transplant may be their best option. But they need to meet certain health goals set by the liver transplant team. Many are medically frail and may need to gain strength before surgery.
This is why UPMC has developed a program of physical therapy for cirrhosis.
We have a dedicated physical therapist for the liver transplant program here at UPMC. This is because liver disease patients are more complex. For example, cirrhosis affects breathing, endurance, and muscle strength.
Pam Bloomer, a senior physical therapist with UPMC’s Starzl Transplant Institute, sees every transplant candidate. She works with them up until transplant, making sure they stay strong. She also works with patients after transplant, helping them rehabilitate.
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Prehabilitation Before Rehabilitation
The American Society of Transplantation Liver (ASTL) recently published a position paper on frailty and liver transplant. They acknowledged that it’s an important factor in deciding if someone is suitable for transplant. This is because people with cirrhosis who are frail have a greater risk of mortality after surgery.
But if they can take part in a physical therapy program before their liver transplant, they have a better chance of survival. “The stronger you go into surgery, the stronger you will be coming out of it,” Bloomer says.
This is the essence of “prehab,” which simply means physical therapy before transplant. UPMC is leading the way in creating new physical therapy protocols for prehab.
Bloomer even co-authored a 2021 American Journal of Gastroenterology study that shows that prehab increases the chances of survival after liver transplant.
How Physical Therapy for Cirrhosis Works
For some people, daily walking or completing a series of exercises videos is enough. But other patients have unique physical limitations. Bloomer designs a more tailored program for each patient.
She may prescribe a series of home exercises. She can also coordinate with other UPMC physical therapists. This way, patients can do outpatient therapy closer to where they live.
Patients who are frail or have very advanced liver disease start with a directive to get at least 1,000 steps a day. Their goal is to ultimately reach 2,500 to 3,000 or more steps.
Patients who are more functional or less sick need to do at least 5,000 steps a day. More robust, healthy patients have a goal of at least 7,500 steps.
Personalized Physical Therapy
A good deal of Bloomer’s work is talking to patients and doing frailty assessments. “I have to make sure I’m prescribing the right exercises to help them achieve the goals for the transplant team,” she says.
Bloomer wants to see each patient become strong enough to qualify for surgery. And after transplant surgery, she wants them to thrive. There is a rehabilitation program waiting for them on the other end as well.
But for most end stage liver disease patients, the best thing she can do is set them up for success, long before transplant.
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About Transplant Services
For more than four decades, UPMC Transplant Services has been a leader in organ transplantation. Our clinicians have performed more than 20,000 organ transplant procedures, making UPMC one of the foremost organ transplant centers in the world. We are home to some of the world’s foremost transplant experts and take on some of the most challenging cases. Through research, we have developed new therapies that provide our patients better outcomes — so organ recipients can enjoy better health with fewer restrictions. Above all, we are committed to providing compassionate, complete care that can change – and save – our patients’ lives. Visit our website to find a provider near you.