Prehabilitation of kidney transplant candidates - a narrative review

Patients with end-stage renal failure frequently present with weakened physical and mental conditions and comorbidities. The results of post-organ transplantation treatment depend not only on the surgical procedure itself, but also on the patient's health before surgery. Solutions continue to be sought to improve these results. The aim of this study was to review the current knowledge on prehabilitation in kidney recipients, including the key components of the approach, and to analyze the scientific evidence regarding its effectiveness. Recommendations of the Polish as well as international transplantation societies are also discussed, pointing out the key aspects required for implementation of prehabilitation protocols in clinical practice. A query was conducted to identify the available Polish- and English-language literature, and the returned hits were synthesized and interpreted in a narrative manner. The available studies are fraught with certain limitations, including the small sizes of the study groups, the variety of interventions, and the lack of standardization in the evaluation of outcomes. In addition, no clear guidelines are available with regard to conducting prehabilitation in kidney recipients, which translates into difficulties in comparing the study results. The benefits of prehabilitation are pointed out along with its important limitations, including organizational ones, that may affect its effectiveness. Most evidence relates to physical support, and the relevant results are satisfactory. However, the effectiveness and applicability of prehabilitation in clinical practice are still a matter of dispute. Prehabilitation prior to kidney transplantation is increasingly recognized as an effective method for improving patient outcomes. It is necessary that multimodal prehabilitation programs be developed and implemented into the standard care of patients awaiting kidney transplantation, as pointed out in the ESOT recommendations.