Page 12 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

Chapter 1
Introduction
Background
Solid organ transplantation is a life-saving intervention for people with end stage organ
failure. After the

rst successful kidney transplantation in 1954, the

rst liver
transplantation in 1963, the

rst heart transplantation in 1967, and the

rst (isolated) lung
transplantation in 1983, major improvements have been made in outcomes, and the
transplants were performed in the EuroTransplant region of which 1,321 were in the
number that has been performed has increased. In 2014, a total of 7,741 solid organ
Netherlands.1

ese numbers translate to 46.8 transplants per million persons in the
EuroTransplant region and 46.6 transplants per million persons in the Netherlands.1
Initially, signi

cant improvements in short-term survival were made due to the
development and evolution of immunosuppressive medication, improved organ
preservation, and surgical techniques.
2,3

e survival curves per era of transplantation have
been running rather parallel in the past decades as indicated for liver transplant recipients
in Figure 1.
Improved overall survival appears to be mainly a consequence of improved
short-term survival. To further increase overall survival after transplantation, focus is
shifting towards improvement of long-term outcomes. Sustaining or improving quality of
life and physical functioning as well as reducing morbidity from cardiovascular diseases are
the primary goals currently being addressed.
Improved physical functioning or functional recovery after transplantation is a goal
that is being addressed due to the fact that functional recovery after transplantation is not
as good as might be expected. Overall, very few transplant recipients have a maximal rate of oxygen consumption (VO2peak) within the normal range, and this reduction in VO2peak is
present despite the restoration of near normal organ function after transplantation.4
Furthermore, maximal exercise capacity is limited and the level of daily activity has shown
to be reduced after transplantation.
5–7
Reducing mortality from cardiovascular disease is indicated as an important goal in
improving long-term survival. Cardiovascular diseases are currently the primary
noncommunicable disease in the general population and accounts for the majority of the
63% of all deaths worldwide that are accounted for by these diseases.8

Organization identi
ed the six risk factors associated with noncommunicable diseases as
e World Health

the leading risk factors for death as being: high blood pressure, tobacco use, high blood
glucose levels, overweight or obesity, high cholesterol levels, and inactivity.
disease.9
cardiovascular disease are of major importance to the long-term survival in the transplant
10.

ese factors
collectively contribute to a large proportion (~42%) of the deaths from cardiovascular
Within the renal transplant population, the incidence of cardiovascular diseases is
reported to be three to

ve times higher when compared to age-matched controls.
10,11
Although most studies have been performed in renal transplant populations, there are
indications that the increased risk is present in the other transplant populations as well. It is likely that these life-style related secondary diseases that are of in uence on
12,13