Functional Outcomes after Inpatient Rehabilitation of Recipients after Living-donor Liver Transplantation

The goal of this study was to investigate the utility of inpatient rehabilitation in eleven recipients that underwent adult-to-adult living-donor liver transplantation (LDLT) using the Functional Independence Measure (FIM) scale. Following transplantation, muscle atrophy was noted in all patients and was worse in the lower limbs. Joint stiffness was also noted in the four limbs, especially in the upper limbs. Assessment with the FIM scale demonstrated low motor scores (mean 16) and low cognitive scores (mean 20) before rehabilitation. Of the six patients that received intensive rehabilitation and were discharged from our institution, inpatient rehabilitation resulted in improvement in joint stiffness but not in muscle atrophy. Of the six patients discharged, final FIM motor scores had improved markedly (mean 61), and the mean postoperative admission period and the mean rehabilitation period were 163 days and 59 days, respectively. However, of the five patients that died from postoperative complications, final FIM motor scores showed no improvement (mean 14). These results suggest that transplant recipients that do not experience critical complications do benefit from inpatient rehabilitation. However, improvements in functional outcome occur over a long time course, and we advocate initiating rehabilitation before LDLT or hospital admission.