Page 43 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

Physical activity in recipients of solid organ transplantation
discharge from the hospital after LTx (T1 [day of discharge or days preceding discharge]),
at 6 months after LTx (T2), and at 12 months after LTx (T3). Data from all patients 18
years of age or older on the date of transplantation were included when data from at least 3
of the 4 measurement moments were available. Data from patients receiving
retransplantation or receiving heart-lung transplantations were excluded. Data were coded
and processed anonymously.
Data regarding the characteristics of the patients, diagnosis, duration on the waiting
list, length of hospital stay (from transplantation to discharge, re

ective of health status,
disease severity, postoperative complications, and recovery rate), and number of rejection
episodes (number of rejection treatments applied) in the

rst year after transplantation
were gathered from medical records. At hospital discharge, all patients were instructed to
exercise regularly. No pre-described training program was provided, but training under the
supervision of a physical therapist was advised, and oral and written referral were provided.
All patients received optimal immunosuppression therapy (tacrolimus [Prograf, Astella
Pharma US Inc, Northbrook, Illinois], mycophenolate mofetil [CellCept, Genentech USA
Inc, South San Franscisco, California], and prednisone).
Indications for transplantation were categorized into 4 groups: COPD and
emphysema, including alpha1-antitrypsin de
syndrome (pulmonary vascular disease group); cystic

brosis, including idiopathic pulmonary

ciency and bronchiectasis (COPD group);
pulmonary vascular diseases, including primary pulmonary hypertension and Eisenmenger

brosis (CF group); and pulmonary
pressure of >30 mm Hg), scleroderma, and bronchiolitis obliterans (pulmonary
brosis, sarcoidosis (with mean pulmonary artery

brosis
group).
Outcome Measures
6MWD
Functional exercise capacity was determined with the 6MWD performed in accordance
with American

oracic Society guidelines
no practice tests were performed before measurement.
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over a 40-meter distance and supervised by an
experienced physical therapist. In accordance with American

oracic Society guidelines,

e number of 6MWD tests that
patients performed in the screening and post-transplant periods ensured that a learning
e
ect was largely ruled out. If possible, patients would walk without an assistive device. An
assistive device (walker) was used only by patients receiving oxygen supplementation in
daily life (before transplantation); the oxygen container was placed on the walker. No
additional oxygen supplementation was used. Predicted walking distance (for adults who
were healthy) was calculated, and a 6MWD below 82% of the predicted walking distance
was considered indicative of impairment.
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Pulmonary function
For all patients, second (FEV1),
f
ow volume measurements, including forced expiratory volume in 1
orced vital capacity, and Ti eneau index (FEV1/forced vital capacity, as a percentage), were obtained. Body plethysmography ( Jaeger, Wurzburg, Germany) was used
41.
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