Page 25 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

Physical activity in recipients of solid organ transplantation
Introduction
Renal transplantation is the optimal treatment for end-stage renal disease.1
population.2
Cardiovascular disease (CVD) is an important driver of this di
However, rates
of mortality in renal transplant recipients (RTR) remain much higher than in the general

erence in
survival rates with the incidence of the disease being three to

ve times higher in RTR
than in the age-matched general population.
At least half of the deaths following a
transplantation are directly attributable to CVD.
3,4

erefore, the reduction of
cardiovascular (CV) risk in RTR is of primary importance.
As the level of PA in RTR is signi
5,6
Both CV and all-cause mortality in RTR are strongly associated with low levels of
physical activity (PA).7

cantly lower than in healthy
subjects, many RTR do not meet the recommended levels of PA.
combination with the known bene

ts of PA in the general population suggest that survival
7–9

ese associations in
in RTR could be improved by the promotion of PA. However, it is plausible that these
associations are partially explained by pre-existing CVD. Heart failure (HF) and coronary
artery disease (CAD) are highly prevalent in RTR, and both are inextricably linked to
exercise intolerance.
CAD in

10–13
It is currently unknown whether comorbidities such as HF and
uence the association between PA and mortality in RTR.
Cardiac biomarkers may contribute to establishing the presence and severity of HF
and CAD.
14
HF severity can be identi

ed with markers of ventricular wall strain such as
mid-regional pro-atrial natriuretic peptide (MR-proANP) and N-terminal-pro brain
natriuretic peptide (NT-proBNP).
cardiac ischemia, is closely related to the severity of CAD.
15,16
High sensitive troponin T (Hs-TnT), a marker of
17,18

ese markers are highly
predictive of mortality in the general population
assessing the relationships between PA, mortality, and pre-existent HF and CAD.
19–21
and o

er a practical method for
Unfortunately, the number of studies validating the predictive value of these cardiac
markers in RTR is limited.
Materials and methods
Design and study population
2,22

is post-hoc study aims to (i) substantiate the association between MR-proANP,
NT-proBNP, Hs-TnT and CV- and all-cause mortality in RTR, and (ii) use these cardiac
markers to investigate the potential role of antecedent heart failure and ischemia in the
association between PA and CV and all-cause mortality.

is study is a post-hoc analysis of a prospective cohort study (TransplantLines Insulin
resistance and In

ammation Biobank and Cohort study) of which the study design
23
and
the primary outcomes have been previously published.7
All adult RTR with a functional
graft (>1year) who visited the outpatient clinic of the University Medical Center
Groningen (UMCG) between August 2001 and July 2003 were invited to participate.
Recipients with overt congestive heart failure or who had been diagnosed with cancer
(other than cured skin cancer) were not considered eligible. Data on PA was available for
23.
2