Abstract: TH-OR116
Smart & Fit for Kidney Transplantation (S&F4KTx): A Randomized Controlled 12-Month Trial on the Effects of an Interdisciplinary Prehabilitation Approach in Wait-Listed Patients
Session Information
- Late-Breaking Research Orals: Dialysis and Transplantation
October 22, 2026 | Location: Four Seasons Ballroom 2, Convention Center
Abstract Time: 05:18 PM - 05:30 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Krusemark, Helge, University Hospital Erlangen, Erlangen, BY, Germany
- Kleemann, Judith, University Hospital Erlangen, Erlangen, BY, Germany
- Hepp, Tobias, Institute Biostatistics, Erlangen, BY, Germany
- Schiffer, Mario, University Hospital Erlangen, Erlangen, BY, Germany
Background
Prolonged waiting times for KTx may be accompanied by loss of muscle mass, frailty and a decline in physical function. We evaluated whether a multimodal prehabilitation program can improve body composition and physical function in KTx candidates.
Methods
In a single-center randomized controlled trial, 169 adults with ESKD listed for KTx were randomized 1:1 to an intervention or control group. The intervention comprised individualized exercise and nutritional recommendations, digital monitoring and the opportunity to participate in a 3-week inpatient interdisciplinary rehabilitation program. Controls received standard care and access to a general information app. Outcomes were assessed at baseline and after 6 and 12 months. The primary outcome was absolute deviation from a target BMI of 22.5 kg/m^2. Secondary outcomes included body composition, physical performance, physical activity, frailty and functional independence.
Results
BMI deviation did not differ significantly between groups at 6 months (difference 0.38 kg/m^2, p=0.109) or 12 months (0.31 kg/m^2, p=0.209). In contrast, skeletal muscle mass was significantly better preserved in the intervention group at 6 months (between-group difference 0.84 kg, p=0.022) and 12 months (0.98 kg, p=0.010). At 12 months, the intervention group also showed greater improvement in sit-to-stand performance (2.64 repetitions, p=0.017) and functional independence: Barthel Index at 6 months (1.39 points, p=0.040) and 12 months (1.80 points, p=0.010). Frailty was significantly improved in the intervention group at 6 and 12 months (both p<0.001). A clinically relevant trend toward improved 6-minute walk distance was observed at 12 months (+21.9 m, p=0.063). No significant differences were observed for fat mass, waist circumference, Timed Up and Go, one-leg stance, stair climbing, handgrip strength, or physical activity.
Conclusion
A multimodal prehabilitation program did not significantly improve the BMI-based primary outcome but was associated with preservation of skeletal muscle mass and improvements in lower-extremity functional performance, functional independence and frailty. These findings suggest KTx candidates benefit from prehabilitation and that body composition and functional outcomes are more sensitive than BMI for evaluating the benefits.
Acknowledgment
The study was registered at ClinicalTrials.gov (NCT06040281). Funding was provided by the Bavarian State Ministry of Health.
Funding
- Government Support - Non-U.S.