Informing prehabilitation for patients awaiting liver transplantation: A scoping review to identify content and design features to meet patient needs

Introduction Patients awaiting liver transplantation (LT) experience multiple challenges, including physical, psychological, and social. To date, no established multicomponent prehabilitation interventions for patients awaiting LT exist. This scoping review aimed to map and synthesise information regarding prehabilitation interventions across major surgical populations to inform a LT prehabilitation intervention. Methods We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and Psychological Abstracts Information Service, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, and the International Standard Randomised Controlled Trial Number registry, from inception to February 17, 2025. Studies evaluating prehabilitation interventions and patient experiences were included and independently screened and charted by two reviewers. Results Two hundred and seven studies were included. Single-component interventions predominated (42%, 65/153), most commonly exercise-based (65%, 100/153). Delivery was most frequently supervised in hospital or community settings (36%, 55/153), with physiotherapists the primary providers (25%, 38/153). Barriers were most often related to environmental context and resources (38%), while facilitators were primarily linked to reinforcement (16%). Aerobic capacity/exercise tolerance was the most frequently reported outcome (50%, 76/153), whereas fatigue (3%, 4/153) and frailty (6%, 9/153) were rarely assessed. Conclusion This scoping review provides the first synthesis of considerations for developing multicomponent prehabilitation for LT. Future interventions should prioritise patient-informed, multidimensional outcomes capturing changes most meaningful to patients, including physical, nutritional and psychosocial domains. Embedding the patient voice in design and evaluation is essential to ensure future prehabilitation interventions address the complex needs of the LT population and support accessible, real-world implementation.