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).

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

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.

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).

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

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

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.

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)

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.

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)

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

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.