Lecture 18: Transplantation Flashcards
Types of Transplantation
- often use achilles tendon, tibialis anterior and semitendinosus
- allograft (homograft): between individuals of same species
- autologous (autograft): within same individual
- xenogeneic (heterograft): between species
- allogeneic: between species but different genes (genetically similar but not identical)
- syngeneic (isograft): between identical people (twins)
- orthotopic: tissue transplanted in normal anatomical position (heart)
- heterotopic: transplanted to another area of body of recipient (kidney)
Overview of Organ Transplant
- whereas some people will have a period of only a few days of physical inactivity before transplantation, the majority of organ candidates will live with their diseased organs for a prolonged period of time
- by the time of organ transplantation, candidates usually have experienced a period of long-term health leading to end-stage organ failure accompanied by severe deconditioning and exercise intolerance
- assessment of transplant candidates must take into consideration daily life and daily activities including potential return to work requirements
Pretransplant Activity and Exercise
- where possible, exercises should be functional, with an emphasis on strengthening the proximal muscles of the pelvis and the lower extremities, especially the gluteal and quadriceps muscles, as well as muscles of the shoulder girdle and trunk to support upper extremity function and accessory respiratory efficiency
- transplant candidates who do take part in an exercise program before surgery are likely to recover more rapidly following transplantation
Posttransplant Activity and Exercise
- despite pretransplant physical deconditioning and exercise limitations, transplant recipients can progressively return to a normal life with return to work and even safely participate in sporting activity and exercise
- research shows that 6 months of specific resistance exercise training restores fat-free mass to levels greater than before treatment and dramatically ↑’s skeletal muscle strength
- gaining density in the lumbar spine is especially important, because up to 35% of transplant recipients develop lumbar spine bone fractures
Guidelines to Activity and Exercise
- duration of beginning exercise should be until fatigue begins; allow for a short recovery period and repeat in an interval manner
- goal is to perform at least 30 minutes of continuous exercise at a moderate exertional level 4-5 times weekly
Limitations on Activity and Exercise
- no contact sports
- other limitations evaluated on a case-by-case basis
- vigorous exercise training for competition is not contraindicated for healthy transplant recipients
- cardiorespiratory fitness and strength training should progress gradually first before the client engages in more strenuous sports participation
SIFTT Kidney Transplant
- acute care: most kidney recipients are discharged in about 5 days following surgery
- exercise: patient may be normotensive at rest, but there is an elevated BP response to exercise requiring careful monitoring and documentation of vital signs
- overuse tendon injuries occur at a high rate in kidney transplant patients: care should be taken to avoid overloading tenons since traumatic ruptures following even small trauma have been reported; fluoroquinolones have been linked as a responsible factor; achilles tendon often involved
SIFTT Liver Transplant
-acute care: patients will have painful abdomen with large abdominal incision and 4-5 inch left axillary incision
-large incisions are contraindications for resistive exercises
-gradual low-resistance training can be introduced as per Dr.
-mild S & S of rejection are present during the first few days (pain, fever, fatigue, change in color of stool (gray) or urine (tea color)
-infection is a much greater concern than rejection
-UE ROM exercises and client education for prevention of adhesive capsulitis are important concerns
-coughing and deep breathing with a pillow splint are taught early
-hand, pedal, and, in men, scrotal edema from dependent positioning frequently develop, requiring AROM in bed and mobility training ASAP
-assisted ambulation as soon as the client is stable in the upright position
-outpatient: pretransplant hepatic encephalopathy usually resolves slowly in the posttransplant period if the donor organ is functioning well
-PT must be alert to self-medicating or use of over-the-counter drugs
-abdominal scar may result in kyphotic posture and altered breathing-need to assist in improving posture, strength, balance, coordination, and fatigue levels
-exercise: extreme weakness and fatigue reducing the clients’ activity level are common
-improvement in exercise capacity with training before transplantation has been shown, and studies confirm the same outcome after liver transplantation
on physical fitness, muscle strength, and functional performance
-compliance with a HEP may be a problem
-liver denervation does not alter release of glucose during physical activity
SIFTT for Heart Transplantation
- acute care: most candidates have experienced months of restricted activity before Sx
- restore mobility/functional skills, ↑ strength, improve balance & coordination
- pulmonary hygiene & breathing exercises are essential to prevent atelectasis
- may have chest pain d/t the surgery, but chest pain d/t ischemia in the early post-op months is unlikely d/t denervation of the heart
- progressive ambulation can be initiated as soon as the client can transfer
- exercise: d/t denervated myocardium, impaired ability to regulate cardiac function
- resting HR after transplantation/denervation is higher than normal
- delayed or blunted heart rate ↑’s occur in response to exercise
- peak HR will only ↑ 15 to 25 beats/min from resting levels
- use RPE scales
- warm-up of at least 5’ required to stimulate catecholamine release
- cool down is also essential
SIFTT for Lung Transplantation
- preoperative: focus on functional mobility, identifying and maintaining or improving strength or motion deficits, and improving breathing patterns
- acute care: Progressive functional mobility
- early mobilization and frequent position changes with postural drainage
- coughing and deep breathing must be relearned because lung is denervated
- learn diaphragmatic breathing (what nerve has to be intact?)
- monitor vital signs and saturation levels (normally be above 93%) closely
- progress treatment from bed mobility to ambulation even if still vented
- outpatient: client education regarding importance of consistently following HEP
- exercise: aerobic endurance-training program improves submaximal and peak exercise performance significantly
- exercise not limited by ventilation even with decrease in tidal volume and respiratory rate-only reach 40-60% VO2max so RPE scale is important
