Inpatient comprehensive rehabilitation after liver transplantation

Liver transplantation has become a standard treatment for liver failure and is covered by Medicare. Transplantation has up to an 80% survival rate; however, the postoperative course can include many complications, a long hospital admission and the need for the involvement of many medical and therapeutic disciplines. Ideally, this is provided by a coordinated comprehensive rehabilitation program, but descriptions of this type of management are absent from the literature. This report describes the case of a 54-yr-old male with alcoholic cirrhosis who underwent orthotopic liver transplantation. His postoperative course was complicated, and he developed global weakness secondary to hepatic neuropathy with superimposed type II steroid-induced myopathy. Four months after the transplant he was unable to sit up in bed and was admitted to the rehabilitation unit. The patient required two subsequent admissions to the acute hospital for complications; however, close cooperation between the surgical transplant team and the rehabilitation team facilitated functional improvement and enabled discharge to home in less than 8 wk. At discharge, the patient was independent in bed mobility, transfers and self-care, and he was ambulating with contact guard. Medical issues, including evaluation, medications and possible complications in the rehabilitative phase are discussed.