Travel to High Altitude Following Solid Organ Transplantation

Abstract

Luks, Andrew M. Clinician's corner: travel to high altitude following solid organ transplantation. High Alt Med Biol. 17:147-156, 2016.-As they regain active lifestyles following successful organ transplantation, transplant recipients may travel to high altitude for a variety of activities, including skiing, climbing, and trekking. This review is intended to provide information for medical providers who may encounter transplant patients seeking advice before planned high altitude travel or care for medical issues that develop during the actual sojourn. There is currently limited information in the literature about outcomes during high-altitude travel following solid organ transplantation, but the available evidence suggests that the physiologic responses to hypobaric hypoxia are comparable to those seen in nontransplanted individuals and well-selected transplant recipients with no evidence of organ rejection can tolerate ascents as high as 6200 m. All transplant recipients planning high-altitude travel should undergo pretravel assessment and counseling with an emphasis on the recognition, prevention, and treatment of altitude illness, as well as the importance of preventing infection and limiting sun exposure. Transplant recipients can use the standard medications for altitude illness prophylaxis and treatment, but the choice and dose of medication should take into account the patient's preexisting medication regimen and current renal function. With careful attention to these and other details, the healthy transplant recipient can safely experience the rewards of traveling in the mountains.

Ambulatory Blood Pressure at Sea Level and High Altitude in a Climber with a Kidney Transplant and Hypertension

“…In this climber with a kidney transplant and hypertension overall mean SBP did not differ by altitude and maximal BP values occurred at SL. He did not develop AMS, suggesting his transplanted kidney was able to respond with appropriate diuresis and natriuresis to help him acclimatize (Luks 2016). In addition, despite immunosuppressant medication, he developed no serious infectious diseases during his trek.…”

“…Hypertension is a common disease in the general population as well as in high altitude trekkers (Keyes, Mather et al 2016). Few studies have looked at individuals with chronic kidney disease or solid organ transplant at high altitude (Luks, Johnson et al 2008, White, Touyz et al 2009, Luks 2016. Whether or not these conditions predispose individuals to developing acute altitude illnesses or other undesirable medical events remains unclear.…”

“…(Goldfarb-Rumyantzev and Alper 2014). Prior investigations suggest that these functions should be preserved in renal transplant recipients (Luks 2016) though only a few reports have examined clinical outcomes of kidney transplant patients at high altitude (White, Touyz et al 2009, Suh, Kim et al 2015, van Adrichem, Siebelink et al 2015 and none of these subjects had the complication of hypertension.…”

Cardiopulmonary, biomarkers, and vascular responses to acute hypoxia following cardiac transplantation

“…In this study, we further investigated the effects of acute exposure to hypoxia at rest and following exercise on cardiopulmonary parameters. Because of some isolated case reports of transplant recipients who could tolerate physical activity at high altitudes, we proposed to comprehensively evaluate the effects of acute hypoxic stress these high‐risk patients. We observed an increase in the ventilatory response, and a lesser desaturation in response to hypoxia in CTx patients.…”