# Experience in Rehabilitation Treatment for Patients Repeatedly Admitted to Intensive Care Units After Dual Graft Living-Donor Liver Transplantation: A Case Report

## TL;DR

This case report describes the rehabilitation of a woman who had multiple ICU admissions after a complex liver transplant, showing how tailored exercises improved her daily living abilities.

## Contribution

The paper provides a detailed case study on individualized rehabilitation strategies for post-LDLT patients with ICU complications.

## Key findings

- Rehabilitation based on ICU mobility scores improved the patient's ADL, as shown by a Barthel index increase from 0 to 55.
- The patient experienced muscle atrophy, particularly in the psoas muscle, due to ICU-acquired weakness and prolonged inactivity.
- Tailored rehabilitation approaches can improve outcomes for LDLT patients, but muscle mass recovery remains a challenge.

## Abstract

Living-donor liver transplantation (LDLT) has become a common procedure in Japan, allowing patients to maintain their activities of daily living (ADL) after surgery. However, complications, such as bile leakage and septic shock, often occur, necessitating intensive rehabilitation. This case report details the rehabilitation of a woman in her 60s who experienced peritonitis and recurrent septic shock after LDLT, with the goal of providing insights for future rehabilitation protocols.

The patient had a preoperative Child-Pugh class C and Model for End-Stage Liver Disease score of 21. Preoperative rehabilitation included gait and muscle-strengthening exercises. After a 15-hour dual-graft LDLT, she experienced multiple postoperative complications, including bile leakage on day X+22, requiring resuturing and multiple intensive care unit (ICU) admissions. Rehabilitation was adjusted to suit her ICU condition, with exercises, such as range-of-motion and assisted walking, based on her ICU mobility score. After her final ICU discharge on day X+55, she continued rehabilitation in a general ward, progressing from wheelchair transfer to walking with a walker, which resulted in Barthel index improvement from 0 to 55 on day X+133. Despite improved ADL, she experienced muscle atrophy, particularly in the psoas muscle, due to ICU-acquired weakness and prolonged inactivity.

This case highlights the importance of individualized rehabilitation approaches in patients with LDLT and associated complications. Given the lack of specific post-LDLT guidelines, particularly for patients with ICU-AW, this report highlights the need for objective indicators, such as heart rate control and muscle strength assessments, to guide rehabilitation. Traditional methods have proven effective in improving ADL; however, further strategies are needed to address muscle mass recovery. This case suggests that a tailored approach can improve patient outcomes and provide valuable insights into the development of LDLT-specific rehabilitation guidelines.