Page 143 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

Physical activity in recipients of solid organ transplantation
controls, con

rming our hypothesis. Furthermore, no indications of rejection or infection
related to this expedition have occurred.
e
As expected, both groups hyperventilated to compensate for high-altitude induced
hypoxemia. However, more pronounced signs of hyperventilation occurred in transplant
participants as indicated by the lower pCO2.
ective in transplant participants than that of the control group as re

e adaptation to high-altitude was less

ected by the lower
bicarbonate in transplant participants.

is resulted in reduced metabolic compensation.
We hypothesize that this is due to the reduced renal function of the transplant participants
(estimated creatinine clearance was reduced to a median of 67 ml/min/1.73m2; data not
shown).

e di

erences between groups at 4030 meters were more moderate and most
likely mitigated by the use of acetazolamide at this altitude (in both groups).
Acetazolamide inhibits carbonic anhydrase resulting in a loss of bicarbonate.
e
equivalent levels of bicarbonate at 4030 meters could possibly be explained by the impact
of acetazolamide being less in subjects with impaired renal function. Di

erences in
absolute capillary blood values, however, were minimal, therefore, clinical signi

cance is
presumably limited.

prerequisite for a high-altitude expedition.
e results do indicate that at least a moderate renal function is a
Although Mount Kilimanjaro is perceived as an easily accessible trekking peak that
can be climbed with minimal climbing experience or technical skills, the reported success
rates of 61% to 77% in the general tourist population combined with a reported oxygen
level at the summit comparable to 10.1% at sea level indicates that climbing Mount
Kilimanjaro requires strenuous performance.
19,20
Hypoxia, (symptoms of ) acute mountain
sickness, low temperatures, basic accommodation, and poor hygienic circumstances
challenge the body and possibly, even more importantly, the mind.

e 67% success rate in
the group of transplant recipients of the current study is comparable to the success rate of
the tourist population.

is summit success rate, however, was lower than the reported
success rate of 83% (5 out of 6) in the expedition with liver transplant recipients.8
A
possible explanation for the higher success rate in the group of liver transplant recipients
could possibly be that all transplant participants in that expedition received dexamethasone
prior to the summit attempt. Although the success rate of the transplant participants in the
current study di

ered from this success rate and the success rate of our control group,
reasons for abandoning the summit attempt were not clearly related to having had an organ
transplant.

e exercise capacity of the three recipients that had to abort the summit
attempt was good to excellent at baseline.
capacity alone is not a strong predictor of a successful summit attempt.
is a feasible undertaking for all OTR.

erefore, it seems that pre-expedition exercise
However, the results of the present study do not suggest that this type of expedition

e generalizability of results is limited due to the
fact that the transplant participants in the current study represent a well-selected and
prepared group that was accompanied by a medical team. Our recommendation to those
willing to undertake a similar extreme expedition would be to have an extensive medical
examination including maximal exercise testing, become physically and mentally well
prepared. Furthermore, people should get informed on adequate hydration, the need to
follow-up the advice of the trained guides to descend when AMS is suspected, and take
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