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During exercise, the muscle signals its energy requirements to the liver by changing the concentration of acylcarnitine in the blood, and the liver adjusts its metabolic activity to increase the synthesis and release of energy substances [223, 224], support muscle contraction and meet the energy demands of exercise [225, 226]

Nonetheless, it also acknowledged that these agents remain underutilized in PTDM management due to limitation of transplant-specific evidence [15]

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