Effects of Short-Term Structural Exercise on Cardiopulmonary Function, Quality of Life, and Oxidative Status in Liver Transplant Recipients: A Case Series.

Abstract

Background: Living donor liver transplantation (LDLT) poses significant physiological challenges, especially during early postoperative recovery. While the long-term benefits of structured rehabilitation are well documented, data on short-term effects-particularly during the critical early inpatient phase-remain limited. This study aimed to evaluate the short-term impact of a structured exercise program on cardiopulmonary function, respiratory muscle strength, physical performance, oxidative stress markers, and quality of life in LDLT recipients. Methods: Four LDLT recipients (2 males, 2 females; mean age 48.00 ± 18.35 years) underwent a 4-week inpatient rehabilitation protocol. Weeks 1-2 involved conventional care, while weeks 3-4 included structured exercise consisting of early mobilization and inspiratory muscle training. Outcome measures included cardiopulmonary exercise testing (CPET), spirometry, maximal inspiratory and expiratory pressures (PImax, PEmax), 6 min walk distance (6MWD), lower limb muscle strength, Chronic Liver Disease Questionnaire (CLDQ), and serum oxidative stress markers (total antioxidant capacity [TAC] and malondialdehyde [MDA]). Results: All patients demonstrated postoperative declines in VO₂ peak, PImax, PEmax, and TAC. Structured exercise yielded clinically meaningful improvements in respiratory muscle strength, notably in female and younger participants. Two younger patients showed increased 6MWD; however, no patient regained preoperative VO₂ peak. TAC levels decreased following the intervention, and MDA levels remained stable in most cases. Conclusions: A two-week structured exercise program during early postoperative recovery may provide partial benefits in respiratory muscle strength and physical performance but is insufficient to restore full cardiopulmonary function in LDLT recipients. Longer rehabilitation periods may be necessary to achieve preoperative recovery levels.