O062 - APP-BASED NUTRITIONAL PREHABILITATION IN PATIENTS WITH CIRRHOSIS AWAITING LIVER TRANSPLANTATION: PRELIMINARY FINDINGS FROM THE OPAL STUDY

O062

APP-BASED NUTRITIONAL PREHABILITATION IN PATIENTS WITH CIRRHOSIS AWAITING LIVER TRANSPLANTATION: PRELIMINARY FINDINGS FROM THE OPAL STUDY

C. Cruz^1,*, C. Gillis^2,3, C. M. Prado⁴, C. Moctezuma-Velazquez¹, N. Selzner⁵, A. Benmassaoud⁶, M. Q. Khan⁷, M. Brahmania⁸, V. Marquez⁹, M. Niazi¹⁰, C. Rose¹¹, C. Bemeur¹², M. McNeely¹³, P. Tandon¹

¹Department of Medicine, University of Alberta, Edmonton, ²School of Human Nutrition, ³Departments of Anesthesia & Surgery, McGill University, Montreal, ⁴Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, ⁵University of Toronto, Institute of Medicine, Toronto, ⁶Department of Medicine, McGill University , Montreal, ⁷Department of Medicine, Western University, London, ⁸Department of Medicine, University of Calgary, Canada, ⁹Department of Medicine, University of British Columbia, Vancouver, ¹⁰College of Medicine, University of Saskatchewan, Saskatoon, ¹¹Department of Medicine, ¹²Department of Nutrition, University of Montreal, Montreal, ¹³Rehabilitation Medicine - Physical Therapy, University of Alberta, Edmonton, Canada

Rationale: Nutritional prehabilitation (prehab) may improve nutritional status in patients awaiting liver transplant (LT). While app-based prehab delivery allows for risk stratified, scalable support, limited data exists in this population.

Methods: A multicenter RCT assessing a 12-week online prehab program with 2:1 randomization to prehab or usual care (UC). Inclusion criteria are adults with cirrhosis listed for LT, pre-frail/frail on a liver frailty index (LFI), and own an internet-connected device. The prehab arm receives an exercise and nutrition program, which includes a protein intake target of 1.2–1.5 g/kg/day with protein powder supplement (30g, 3 or 7 days/week), digital platform, nutritional assessment and follow ups. Increasing nutritional support is provided based on patient generated subjective global assessment category (PGSGA) at baseline (BL). Between-group changes in protein intake (ANOVA) and proportion of participants reaching target protein intake (Fisher’s test) at 12-weeks vs. BL are explored.

Results: To date, 95 participants have been randomized. 59% were male, with mean age of 57 (SD 11.0) and LFI of 4.0 (prefrail, SD 0.6). At BL, 27% were well nourished (n=26), 39% had moderate/suspected malnutrition (n=37), and 34% were severely malnourished (n=32). For those with end of study data, 32% (12/37) of participants in the prehab arm improved their PGSGA category (C to B or B to A) vs. 14% (2/14) in UC. The mean between-arm difference in protein intake was 51.5 g/day [95% CI: 25.7-77.4 p<0.001]. A greater proportion of participants in the prehab arm reached target protein intake compared to UC at 12-weeks (92%:33/36 vs. 53%:9/17, p=0.002).

Conclusion: A risk-stratified, app-based nutritional prehab program offers a scalable nutrition intervention by tailoring resources to risk of malnutrition and optimizing protein intake in patients awaiting LT.

Disclosure of Interest: C. Cruz Grant / Research Support from: CIHR, C. Gillis Speakers Bureau of: Abbott Nutrition, Fresenius Kabi, and Nestlé Healthcare, C. Prado Consultant for: Abbott Nutrition, Fresenius Kabi, and Nestlé Healthcare, Other: Speaker Engagement: Abbott Nutrition, Nutricia, Nestle Health Science, Novo Nordisk, C. Moctezuma-Velazquez: None declared, N. Selzner: None declared, A. Benmassaoud: None declared, M. Khan: None declared, M. Brahmania: None declared, V. Marquez: None declared, M. Niazi: None declared, C. Rose: None declared, C. Bemeur: None declared, M. McNeely: None declared, P. Tandon Grant / Research Support from: CIHR