Exercise and sport after organ transplantation.
Authors: P Griffin
Journal: British Journal of Sports Medicine (1998)

Exercise and sport after organ transplantationTransplantation for the treatment of end stage organ failure has been one of the major medical advances of the last 20-30 years.The success of this form of treatment has improved dramatically with better understanding of the rejection process and introduction of more eVective immunosuppressive regimens so that patients now live longer.Their quality of life can be further enhanced with regular exercise, which is also important as it lowers the risk of cardiovascular disease and diabetes. 1This is especially important in transplant recipients as many immunosuppressive drugs can be atherogenic and diabetogenic. 2y the time of organ transplantation, patients have suVered a period of chronic ill health leading to end stage organ failure and accompanied by severe deconditioning and exercise intolerance.There may often be psychological disturbance with little motivation for exercise and sport.End stage organ failure aVects the whole body, with patients exhibiting severe exercise intolerance, weakness, dyspnoea on exertion, and fatigue. 3fter organ transplantation the underlying pathophysiological process returns towards normal.The extent of this recovery depends on the function of the transplanted organ, which in turn is determined by the quality of the organ donated (young or old donor, any significant pre-morbid pathology), the quality of organ retrieval, and the occurrence or not of any rejection.With a well functioning organ, factors that prevent normality include residual sequelae of the underlying disease process and the complications of long term immunosuppressive therapy.Psychological factors can also cause problems. 4he kind of organ that has failed-that is, kidney, heart, lung, or liver-will determine some of the problems that the individual may suVer in relation to sporting activity.Renal failure and long term dialysis can cause renal osteodystrophy, decreased bone density, osteoporosis, reduced peak cardiac output (because of the arteriovenous fistula required for vascular access), neuropathies, and myopathies.In association with diabetes, a potent cause of renal failure, there are also problems of visual and vascular disorder.Cardiac failure due to ischaemic cardiomyopathy may well be associated with other ischaemic conditionsfor example, claudication.The transplanted heart is denervated and thus there is loss of vagal response.There may also be allograft vasculopathy, a manifestation of chronic rejection, which will cause increasing ischaemia of the transplanted heart.In patients with severe pulmonary disease necessitating heart/lung transplantation, there is often malnutrition and muscle wasting.Liver failure can cause abnormalities of lung function including ventilationperfusion mismatching and loss of oxygen diVusing capacity.The degree of secondary organ involvement is dependent on the course of the illness.The patient who undergoes emergency liver transplantation for acute liver failure will have relatively little secondary damage.Exercise involves two sorts of risk in transplant recipients, that dependent on the exercise and that dependent on the disease.In normal individuals, exercise is healthy and relatively safe, although there is potential for injury from acute trauma or overuse syndrome determined by the demands of the sport.These risks are present for any participant, and transplantees are no exception.It is common to think that the principal risk is cardiovascular, but this applies generally to the high risk population.In addition to these exercise related risks, transplantees have