ORGAN TRANSPLANTATION IS ONE OF THE MOST complex surgical procedures in modern medicine. In 1954, Dr. Joseph Murray and Dr. David Hume of Brigham Hospital in Boston first successfully transplanted a human kidney from a living donor to his identical twin recipient. In 1967, Dr. Christiaan Barnard in Cape Town, South Africa, was the first to perform a human heart transplant. Notably, in the 1970s, Dr. Jean-Francois Borel discovered cyclosporine, a derivative of soil fungus that remains a key component in most transplant patients’ immunosuppressive therapy regimens today. These initial efforts did not have encouraging survival rates and over the next few decades, advances in immunosuppressant therapies and tissue typing helped to improve transplant procedure outcomes and prolong survival. Given that transplant patients are surviving longer, the ultimate goal of organ transplantation, recovery, and rehabilitation is to return these patients to the highest level of function and livelihood as possible.
Renal transplants are the most common organ transplant procedure performed in the United States, with over 16,000 procedures performed annually since 20101 (Fig. 86–1).
Patients on the waiting list and the number of organ transplants performed, 2009. KP = kidney and pancreas. (Data from the Scientific Registry of Transplant Recipients Annual Report (SRTR), http://srtr.org)
Renal transplants are followed by liver, heart, lung, pancreas, bowel, and multivisceral transplants. The most successful transplant procedures (kidney, heart, liver) have 5-year survival rates of around 70% to 80% (kidney, heart, liver; see Fig. 86–2). This is in contrast to the survival rates of other organs (lung, pancreas, intestine) whose survival rates are closer to 40% to 50%. Rehabilitation begins before a transplant occurs and continues through community reintegration.
Survival rates of cardiac transplant patients. (Reprinted with permission from International Society for Heart and Lung Transplantation. 2015 Registry. 2015 [Accessed 10 May 2016]. Available from:https://www.ishlt.org/registries/)
This chapter will provide an overview of the role of Physical Medicine and Rehabilitation (PM&R) in the management and functional restoration of transplant patients. Organ-specific considerations and complications will be discussed, relevant to the patient's course in both the immediate and long-term postoperative period. The chapter will track the phases of rehabilitation from before transplant through integration back into the community.
Preoperative rehabilitation (“prehab”) has received strong support in the literature with regard to management of a wide variety of conditions including solid organ transplants. This patient population is prone to muscle weakness, fatigue, extended hospitalizations, and decreased functional mobility. A recent meta-analysis2 demonstrated that a walking intervention prior to transplant improved cardiorespiratory fitness, self-reported physical function, and pain. Furthermore, a training exercise program for patients awaiting solid organ transplantation has been recommended ...