1213 - The Role of Acute Inpatient Rehabilitation in Addressing Multifactorial Debility After Sequential Lung–Liver–Kidney Transplant Complicated by Severe Dysphagia: A Case Report

Multifactorial debility following sequential lung–liver–kidney transplantation complicated by severe dysphagia and malnutrition
 

Case Description:

A 68-year-old man with idiopathic pulmonary fibrosis, initially denied lung transplantation in 2022 due to portal vein thrombosis and portal hypertension, underwent bilateral lung transplantation on 1/4/23 after multidisciplinary reassessment at Miami Transplant Institute. Early recovery was complicated by pleural effusions, sternal plating, atrial fibrillation, and antibody-mediated rejection, treated with rATG, plasmapheresis, corticosteroids, and IVIG. He achieved community ambulation through outpatient rehabilitation. Further complications, including hepatic decompensation, pancytopenia, ascites, and Serratia bacteremia, necessitated combined liver and kidney transplantation on 2/7/25.

Admitted to inpatient rehabilitation on 3/29/25, NPO and wheelchair-bound, he progressed over 20 days to ambulate 15 meters, regained partial oral intake, and healed a sacral ulcer. Despite GJ tube obstruction requiring IR exchange, he was discharged with home health care and outpatient PT/OT/SLP on 4/29/25. At subsequent clinic follow-up, he demonstrated weight gain, improved functional independence, and FEV₁ at 68% of his personal best.
 

Discussions:

This case underscores the feasibility and value of comprehensive rehabilitation across three serial solid-organ transplants. Key insights include:
● Timing matters: Initiating intensive rehabilitation within three weeks of liver–kidney transplantation facilitated rapid gains in swallowing and mobility, despite severe dysphagia.

● Enteral access is fragile: Prompt recognition and IR exchange of a malfunctioning GJ tube prevented further deconditioning.

● Interdisciplinary coordination: Close coordination among physiatry, nutrition, and surgical team sustained rehabilitation progress.

Current transplant literature rarely addresses serial‐organ recipients; our experience suggests that aggressive, stage-specific rehabilitation remains effective when medical and surgical complications are promptly managed.
 

Conclusions: Early, coordinated inpatient rehabilitation can restore near-independence in medically complex patients undergoing sequential lung, liver, and kidney transplantation, even in the presence of severe dysphagia and physical deconditioning. Vigilant enteral access management, robust nutritional support, and interdisciplinary communication are critical to sustaining rehabilitation gains.