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Pediatric rehabilitation after kidney transplantation

21-06-2018
In the context of rehabilitation for children with pediatric kidney transplantation, A. Bjerre et al. conducted a study into the improvement of oxygen uptake (VO2 peak), mental health and quality of life. The study was conducted among all children and adolescents (1-18 years) with a kidney transplant during the period December 2000 - April 2015 at Oslo University Hospital (OUS), the only transplant center in Norway.

Since 2010, the physiotherapeutic protocol has been intensified after transplantation, so patients receiving physiotherapy are treated regularly 1-2 weeks after transplantation, with individualized intensity increases (2-3 times per week or longer). While it is being transplanted into the pediatric ward, the physical therapy protocol is initiated and continued in an outpatient clinic until it is transferred to a local hospital about 3 months after the transplant. Children are encouraged to participate to the same extent in sport and daily physical activities as their healthy peers at every check in the outpatient clinic. In doing so, the safety of physical activity and its importance with regard to prevention of CVD is constantly emphasized.

This study estimates the effects on peak oxygen uptake (VO2 peak), QoL and mental health after the introduction of an adjusted post-transplant follow-up program, ie, early physical therapy and focus on the importance of physical activity.

The VO2 peak was measured with a treadmill test in 20 renal transplant children at the adjusted post-graft follow-up and compared with a group of 22 patients examined in an earlier study, for the implementation of the new follow-up routines. PedsQL and the Strengths and Difficulties Questionnaire (SDQ) were used to assess QoL and mental health in 45 new patients compared with 32 patients in the previous follow-up strategy.

Patients who were exposed to early physiotherapy and a higher focus on physical activity had significantly higher VO2 peak (44.3 versus 33.5 ml kg-1 min-1, P = 0.031) in addition to improved QoL (P = .003) and scores for mental health (P = .012). The cardiovascular risk profile was similar in both groups except for significantly higher triglycerides in the current cohort. Small efforts such as early physical therapy and increased attention to physical activity after pediatric renal transplantation have a significant impact on cardio respiratory fitness, QoL and mental health. The importance of physical exercise should therefore be emphasized in follow-up programs.

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