Overview of Kidney and Liver Organ Transplantation
Kidneys and livers comprise the greatest number of successful transplantations. The majority of candidates for kidney transplants have end-stage kidney disease resulting from type 1 diabetes, and the majority of liver transplants are for individuals with end-stage liver disease. The number of successful candidates for these transplants has increased due to an increased understanding controlling organ rejection and other complications of these disease processes. Transplant rejection occurs in 10% to 20% of all cases, usually within the first 3 months, but rejection can occur years later. Post-transplant musculoskeletal pain, especially the knee and ankle joints, is common in the first 6 months, affecting up to 35% of individuals receiving a renal transplant and 25% of liver transplants. After receiving a kidney or liver, clients may have limited mobility and endurance from excessive fatigue. Complications from their diseases and side effects of their numerous drugs affect physical activity.
Comorbidities to Consider
Clients may have significant cardiopulmonary and musculoskeletal complications after organ transplantation. Recipients of kidneys are at increased risk of osteoporosis, osteonecrosis, sensory polyneuropathy, and the fractures associated with these conditions.1 Excessive body fat mass has been associated with physical inactivity and steroid use in clients after transplantation.2,3
Keys to Examination of Clients
Assess the results of recent tests for blood counts and for cardiac and pulmonary function.
Measure fatigue levels before and during exercise programs.3,4
Employ the Health-Related Quality of Life inventory to assess clients' current physical function, pain, and general health status.5
Recommended Baseline Testing of Fitness Levels
Aerobic capacity can be assessed by walking or treadmill tests to determine peak aerobic capacity and maximum heart rate.
Strength of the large muscle group has been assessed by isometric or isokinetic testing.
Screen for limited mobility and signs of degenerative conditions to prescribe the appropriate types and parameters of exercise.
Type: Walking, cycling, and home-based activities2,6
Intensity: Start at 60%–65% of maximum heart rate
Duration: Progress to 30 minutes
Frequency: Three times per week
A fitness support group may benefit clients having similar procedures and disease processes.7 Circuit resistance training is recommended for clients with a stable health status, beginning with low intensities with 12 to 15 repetitions for one to two sets of upper and lower extremity exercises. Such exercises can be used to improve muscle strength and functional levels. Aerobic and resistive training programs can be alternated on a daily basis to maintain a regular behavior of exercise while allowing for recovery from each exercise session. By engaging in ...