Tolerance of Organ Transplant Recipients to Physical Activity during a High-Altitude Expedition: Climbing Mount Kilimanjaro.

Edwin J Van Adrichem,Cees P Van Der Schans,Greetje Kuiken,Bart L Rottier,Marion J Siebelink,Erik A M Verschuuren,Janneke M Dilling,Kathrin Eller

doi:10.1371/journal.pone.0142641

Abstract

BackgroundIt is generally unknown to what extent organ transplant recipients can be physically challenged. During an expedition to Mount Kilimanjaro, the tolerance for strenuous physical activity and high-altitude of organ transplant recipients after various types of transplantation was compared to non-transplanted controls.MethodsTwelve organ transplant recipients were selected to participate (2 heart-, 2 lung-, 2 kidney-, 4 liver-, 1 allogeneic stem cell- and 1 small bowel-transplantation). Controls comprised the members of the medical team and accompanying family members (n = 14). During the climb, cardiopulmonary parameters and symptoms of acute mountain sickness were recorded twice daily. Capillary blood analyses were performed three times during the climb and once following return.ResultsEleven of the transplant participants and all controls began the final ascent from 4700 meters and reached over 5000 meters. Eight transplant participants (73%) and thirteen controls (93%) reached the summit (5895m). Cardiopulmonary parameters and altitude sickness scores demonstrated no differences between transplant participants and controls. Signs of hyperventilation were more pronounced in transplant participants and adaptation to high-altitude was less effective, which was related to a decreased renal function. This resulted in reduced metabolic compensation.ConclusionOverall, tolerance to strenuous physical activity and feasibility of a high-altitude expedition in carefully selected organ transplant recipients is comparable to non-transplanted controls.

Highlights

With the increased focus on long-term survival after organ transplantation, new questions are emerging regarding physical possibilities and potential boundaries or limitations following organ transplantation
Eleven of the transplant participants and all controls began the final ascent from 4700 meters and reached over 5000 meters
Cardiopulmonary parameters and altitude sickness scores demonstrated no differences between transplant participants and controls

Summary

Introduction

With the increased focus on long-term survival after organ transplantation, new questions are emerging regarding physical possibilities and potential boundaries or limitations following organ transplantation. Maximal oxygen consumption is demonstrated to be significantly reduced with kidney and liver-tx recipients and lung and heart-tx recipients, respectively reaching 65–80% and 50–60% of predicted [7]. These data suggest that strenuous PA, especially in an exceptional environment, would not be feasible for OTR. Carefully selected and prepared liver transplant recipients appear to be tolerant to PA in, and exposure to, high-altitude as healthy controls [8]. During an expedition to Mount Kilimanjaro, the tolerance for strenuous physical activity and high-altitude of organ transplant recipients after various types of transplantation was compared to non-transplanted controls

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