Physical performance after pediatric solid organ transplantation

Abstract

Introduction Low physical activity is a well‐recognized problem in pediatric solid organ transplant recipients; however, little is known about the differences between transplant groups. Physical performance testing was performed in a cohort of pediatric kidney, liver, and heart transplant recipients. Methods Fifty‐one patients (54.9% boys), including 17 liver, 20 kidney, 2 combined liver‐kidney, and 12 heart transplant recipients, were tested at the median age of 11.5 (7.5–14.9) years. The results were compared with a control group, which consisted of 425 healthy schoolchildren. The physical performance test included six different tests of endurance, strength, flexibility, and speed. Results The transplant recipients performed worse on most tests when compared with the control subjects (leg‐lift test 42.0 vs. 44.9 repetitions, p = .002; repeated squatting 21.6 vs. 23.9 repetitions, p < .001; sit‐up test 9 vs. 17 vs. 9 repetitions, p < .001, back extension 20 vs. 35 repetitions, p < .001; and shuttle run test 26.5 vs. 23.7 seconds, p < .001). None of the test results differed statistically significantly between the transplant groups. Conclusion The physical performance of pediatric solid organ transplant recipients is lower than that of their healthy peers but do not differ between different transplant groups. More systematic rehabilitation programs and follow‐up are needed.

Physical performance capacity after pediatric kidney transplant and clinical parameters associated with physical performance capacity

“…The difference between the groups was seen especially in tests measuring core muscle strength, i.e., sit-up and back extension, although the difference did not reach statistical significance. Similar findings of reduced core muscle strength were seen in our previous study concerning all pediatric solid organ transplant groups [2], which raises questions of why core muscle strength is especially affected after transplantation. Recipients with CNS have multiple possible explanations, including long-lasting hypoproteinemia, altered muscle structure regarding CKD [35] and sedentary lifestyle [36].…”

“…In addition, 12 recipients did not participate in the study due to other reasons, such as scheduling or logistic problems. This study cohort included 19 recipients from our previous study [ 2 ] with the addition of five previously unassessed recipients. These five recipients were added to increase the number of recipients in the study and because the testing continued as a routine physiotherapy check-up in our follow-up protocol.…”

“…Physical performance was evaluated using a standardized test set, which has been described in our recent study [ 2 ], as well as in studies on the outcomes of pediatric autologous stem cell transplantation [ 14 ] and non-transplanted childhood leukemia survivors [ 15 ]. The tests were partly modified from those generally used in healthy subjects, such as Eurofit [ 16 , 17 ].…”

“…We, among others, have shown that the physical performance of pediatric patients with a history of solid organ transplantation is decreased [ 2 ]. Muscle deficits and altered muscle metabolism affect pediatric patients with CKD [ 3 , 4 ], although Matsumoto et al [ 5 ] demonstrated that the abnormalities in the oxidative metabolism of muscles in children with severe kidney failure are reversed with successful kidney transplantation.…”

“…We therefore compared physical performance between CNS patients and other kidney transplant recipients to see whether there are any differences between the two groups. We hypothesized that physical performance would be inferior in pediatric kidney transplant recipients when compared to controls, as previously stated [ 2 ]. We also assumed that at least measured GFR (mGFR) and BMI would correlate with physical performance.…”