The Role Of Three-Month Program Of Rehabilitative Exercise After Heart Transplantation: The Effects Of The Recipients And Donors Risk Factors On The Exercise Capacity Early After Heart Transplantation

Abstract

Introduction: Although previous studies have shown that the recipients exhibit improvements in exercise capacity and performance after heart transplantation (HTx), the recipients often have a lower exercise capacity than normal healthy age and gender-matched controls in the early period or long after HTx. The purpose of this study is to elucidate the effects of the recipient and donor risk factors on the patient’s exercise capacity early after HTx. Methods: We retrospectively reviewed the medical records of 50 HTx recipients transplanted from April 2010 to November 2016 at National Cerebral and Cardiovascular Center (NCVC) in Japan. Patients’ medical records were reviewed retrospectively for clinical parameters, including demographics of the recipient, recipient nutritional risk factors, demographics of the his/her donor and other risk factors for the donor heart. Three weeks after HTx, if patients have no episode of rejection or other adverse events, three-month program of rehabilitative exercise under the supervision of experienced personnel was initiated. Each recipient underwent symptom-limited cardiopulmonary exercise test at the entry and the end of 3-month program. Results: The peak VO2 was significantly increased after 3-months program in patient irrespective of recipient risk factors, such as recipient age, underlying heart disease, type of LVAD implanted for bridge to transplant, cerebrovascular complications during awaiting HTx, and several nutritional factors, such as serum choline esterase, serum albumin, blood lymphocyte counts and Geriatric Nutritional Risk Index as well as donor risk factors, such as donor age, history of cardiopulmonary resuscitation, total ischemic time, low left ventricular ejection fraction of the donor heart, and inotrope dosage prior to procurement surgery. Discussion: Younger recipient age, higher serum choline esterase and higher blood lymphocyte counts at the entry were significantly associated with higher peak VO2 at the entry and end of 3-momths program. Conclusion: 3-months rehabilitation exercise increased peak VO2 irrespective of main recipient or donor risk factors predictive on heart recipient survival, which included the type of LVAD and marginal donor heart factors. Only recipient age and several nutrition factors at the entry of 3-months exercise were associated with peak VO2 at the entry or the end of 3-months program, and these data suggested that nutrition management and rehabilitation at bedside between the time of HT and the entry of 3-months program play a significant role in increasing peak VO2 at the entry of rehabilitation program.