Exercise Limitation Following Transplantation

Abstract

Organ transplantation is one of the medical miracles or the 20th century. It has the capacity to substantially improve exercise performance and quality of life in patients who are severely limited with chronic organ failure. We focus on the most commonly performed solid‐organ transplants and describe peak exercise performance following recovery from transplantation. Across all of the common transplants, evaluated significant reduction in o 2 peak is seen (typically renal and liver 65%‐80% with heart and/or lung 50%‐60% of predicted). Those with the lowest o 2 peak pretransplant have the lowest o 2 peak posttransplant. Overall very few patients have a o 2 peak in the normal range. Investigation of the cause of the reduction of o 2 peak has identified many factors pre‐ and posttransplant that may contribute. These include organ‐specific factors in the otherwise well‐functioning allograft (e.g., chronotropic incompetence in heart transplantation) as well as allograft dysfunction itself (e.g., chronic lung allograft dysfunction). However, looking across all transplants, a pattern emerges. A low muscle mass with qualitative change in large exercising skeletal muscle groups is seen pretransplant. Many factor posttransplant aggravate these changes or prevent them recovering, especially calcineurin antagonist drugs which are key immunosuppressing agents. This results in the reduction of o 2 peak despite restoration of near normal function of the initially failing organ system. As such organ transplantation has provided an experiment of nature that has focused our attention on an important confounder of chronic organ failure‐skeletal muscle dysfunction. © 2012 American Physiological Society. Compr Physiol 2:1937‐1979, 2012.

Posttransplant Sarcopenia: An Underrecognized Early Consequence of Liver Transplantation

“…Finally, increased physical activity after liver transplantation has been shown to be effective in improving quality of life and decreasing metabolic and orthopedic complications [84]. Even though increased physical activity and exercise have been shown to be beneficial in improving body composition and lean body mass after renal and heart transplantation, there are limited data on the impact of regular exercise on outcomes after liver transplantation [18, 28, 85–87]. Cross-sectional studies suggest persistently impaired exercise capacity after transplant [18].…”

“…Even though increased physical activity and exercise have been shown to be beneficial in improving body composition and lean body mass after renal and heart transplantation, there are limited data on the impact of regular exercise on outcomes after liver transplantation [18, 28, 85–87]. Cross-sectional studies suggest persistently impaired exercise capacity after transplant [18]. These data suggest that, despite the large number of liver transplants performed in the USA and globally, little has been done to reverse the adverse skeletal muscle consequences.…”

“…Therefore, reduction in or failure to regain skeletal muscle mass after liver transplantation is likely to have health-related and economic consequences. A recent comprehensive review showed limitation in exercise capacity following transplantation, and one of the potential reasons suggested was failure to reverse muscle loss after transplantation [18]. Posttrans-plant obesity and metabolic syndrome are common after transplantation [19].…”

Rehabilitation in Patients before and after Lung Transplantation

“…An important contributor to the persisting reductions in exercise capacity is peripheral muscle dysfunction [8,11,17,18,19,20]. Reduced muscle mass and reductions in quadriceps strength are consistently observed in the pretransplant period, and these reductions have been shown to persist up to 3 years into the posttransplant period [21].…”

Long-term nutritional and cognitive outcomes after liver transplantation in childhood

“…Limited exercise capacity was noted in adults post-transplant and was postulated to be due to failure of reversal of muscle loss after transplantation 42 . In children, decreased exercise tolerance has been reported after liver transplantation, and may be improved with physical training 43 .…”