Physical Therapy in Organ Transplantation

Physical Therapy Department

• Focuses on physical therapy for surgery and dermatology
• Part of the Faculty of Physical Therapy at MTI University

Role of Physical Therapy in Organ Transplantation

• Transplantation replaces diseased organs, improving survival and function.
• Grafts can be placed at anatomical normal sites (e.g., heart, liver transplants) or abnormal sites (e.g., kidney transplants into the iliac fossa).

Transplant Types

• Autografts: Patient's own tissue (e.g., bone, bone marrow, skin)
• Syngeneic/Isografts: Genetically identical donor tissue (e.g., monozygotic twins)
• Allografts/Homografts: Genetically dissimilar donor tissue
• Xenografts/Heterografts: Grafts from a different species

Transplanted Tissues

• Cells (e.g., hematopoietic stem cells, lymphocytes)
• Organ parts/segments (e.g., liver, pulmonary lobar transplants, skin)
• Entire organs (e.g., heart, liver, kidney)
• Tissues (e.g., corneas)

Contraindications (Reasons to avoid a transplant)

• Absolute:*
• Active infection
• Cancer
• Positive cross-match (identified via lymphocytotoxic testing)
• Relative:*
• Age over 65
• Poor functional/nutritional status (severe obesity)
• HIV infection
• Multi-organ insufficiency

Kidney Transplantation

• A procedure to replace failing kidneys with a healthy donor kidney.
• Typically classified as cadaveric or living-donor transplant, depending on the donor source.
• Chronic kidney disease is the primary condition requiring such transplants. Kidney damage stemming from conditions like diabetes or high blood pressure often causes end-stage renal disease.

Renal Transplantation: Special Considerations

• Decreased kidney function: Increased serum creatinine and protein in the urine
• Blood pressure: Increased due to fluid overload and vasoactive hormone production. This can lead to hypertension and heart failure.
• Hyperkalemia: Potassium buildup in the blood leading to complications like cardiac arrhythmias and malaise.
• Fluid overload: Water retention and low serum albumin which results in mild edema (swelling) and severe pulmonary edema (fluid in the lungs).

Renal Transplantation: Changes in Mineral and Bone Metabolism

• Increased phosphorus: High phosphorus (phosphate) levels (greater than 0.8-1.4 mmol/l)
• Increased parathyroid hormone: Elevated parathyroid hormone levels.
• Decreased calcium: Low calcium levels (less than 2.2-2.6 mmol/l)
• Disrupted metabolism: Affecting calcium and vitamin D, leading to hypocalcemia (low calcium levels)
• Metabolic abnormalities in bone tissue: Bone turnover, mineralization, volume, linear growth, and skeletal strength are impacted.
• Soft tissue calcification: Vascular and other soft-tissues can become calcified

Renal Transplantation: Additional Issues

• Urea accumulation: Leading to azotemia (high levels of nitrogen compounds) and uremia.
• Metabolic acidosis: Impacts enzyme function and increases excitability of cardiac/neural membranes.
• Anemia: Often seen in patients on hemodialysis, resulting from inflammation, reduced erythropoietin, and hyperuricemia.
• Atherosclerosis: Leading to cardiovascular disease

Renal Transplantation: Procedure

• Existing, non-functioning kidneys often aren't removed.
• Transplanted kidney is usually placed in the iliac fossa, away from the original kidney's location. This is due to a different blood supply connection.
• Renal artery and vein of the new kidney are connected to the external iliac artery and vein of the recipient.
• Living-donor transplant generally requires 3-5 days of recovery to normal operation. Cadaveric graft procedures take 7-15 days. Typical hospital stays are 4-10 days post-transplant.

Complications Post-Transplant

• Post-operative complications (bleeding, infection, vascular thrombosis, urinary problems)
• Transplant rejection
• Electrolyte imbalances (calcium and phosphate) which can lead to bone-related issues.
• Recurrence of the original kidney failure cause.
• Medication side effects (gastrointestinal issues, ulcers, obesity, acne, diabetes)
• Proteinuria (protein in the urine)
• Hypertension (high blood pressure)

Immunotherapy post-transplantation

• The primary challenge is the recipient's immune system rejecting the transplant.
• Medications to suppress the immune system are crucial, though long-term use heightens the risk of infections.
• These medications carry multiple side effects which include glucose intolerance and diabetes, weight gain, osteoporosis, muscle weakness, infections, high cholesterol, and cataract formation.

Signs and Symptoms of Rejection

• Fever
• Flu-like symptoms
• Kidney area tenderness
• Fluid retention
• Weight gain (more than 2-4 pounds in 24 hours)
• Decreased urine output

Physical Therapy Considerations for Kidney Transplant

• Exercise effects on blood glucose control.
• Cardiovascular rehabilitation.
• Osteoporosis management and precaution for resistive training.
• Close monitoring of vital signs (blood pressure and heart rate) before and during exercise
• Known risk of tendon injuries due to medication use are increased (corticosteroids, fluoroquinolones)

Limitations of Transplant Candidates/Recipients

• Reduced exercise and functional capacity
• Lower health-related quality of life
• Weakness
• Muscle atrophy
• Decreased bone density
• Increased fatigue
• Decreased cardiopulmonary capacity (40-60%)
• Psychosocial factors

Functional Impairments

• Posture changes due to breathing patterns
• Flexibility impairments
• Skeletal muscle weakness
• Endurance changes in muscle/activity
• Activities of daily living (ADL) impairments
• Need for assistive devices
• Anxiety/Depression

Goals for the Patient (Pre-Transplant)

• Preserve muscle strength and endurance, focusing on proximal muscles to counter corticosteroid effects
• Maintain upper/lower extremity function, improve breathing mechanics
• Maximize functional abilities
• Educate on post-transplant expectations

Exercise and the Pre-Operative Patient

• Increased work capacity
• Improved muscle efficiency
• Improved psychosocial outlook(anxiety and depression lessened)

Goals for the Patient (Post-Transplant)

• Enhance muscle strength and endurance
• Improve exercise capacity
• Optimize quality of life
• Patient education including signs and symptoms of rejection, osteoporosis prevention, and management of co-morbidities such as diabetes.

This quiz explores the vital role of physical therapy in organ transplantation, examining various graft types and their implications for recovery. Learn about the different transplanted tissues and the contraindications associated with transplantation procedures within the context of physical therapy practices.