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Characterising recovery from renal transplantation and live-related donation using cardiopulmonary exercise testing

Angell, Johanna; Dodds, Nicholas; Darweish-Mednuik, Alia M ; Lewis, Simon; Pyke, Mark; Mitchell, David C; Hamilton, Kay; White, Paul; Tolchard, Stephen

Authors

Johanna Angell

Nicholas Dodds

Alia M Darweish-Mednuik

Simon Lewis

Mark Pyke

David C Mitchell

Kay Hamilton

Paul White Paul.White@uwe.ac.uk
Associate Professor in Applied Statistics

Stephen Tolchard



Abstract

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: An association between end-stage renal failure and exercise intolerance exists. Whether live kidney donation impacts on exercise tolerance is unknown. Here recovery post renal transplant and donation using cardiopulmonary exercise testing is investigated. Methods: Renal donors (n = 28) and recipients (n = 24) undertook a cardiopulmonary exercise test, Duke activity score index and patient reported health score questionnaires pre-operatively and in the 7th and 14th week post-operatively. Anaerobic threshold, peak oxygen uptake and ventilatory equivalents were measured in relation to activity and reported health scores. Haemoglobin and renal function was recorded. Results: Recipients showed impaired cardiopulmonary function compared to donors with lower anaerobic threshold (10.5 vs. 14.4 ml/kg/min) and peak oxygen uptake (18.5 vs 23.0 ml/kg/min). Post-operatively the anaerobic threshold of recipients improved and normalised by the 14th week, whereas that in donors fell by ∼20% by the 7th (mean 11.4 ml/kg/min), recovering by the 14th (mean 15.6 ml/kg/min). Reported health but not activity scores showed similar changes. Conclusions: Recovery following renal transplantation and donation differ. Transplantation improves renal function resulting in an increase in anaerobic threshold and peak oxygen uptake which essentially normalise by the 14th week post-operatively. Donors suffer a 20% reduction in cardiopulmonary reserve post-operatively, which recovers by the 14th week, suggesting no associated chronic exercise intolerance.IMPLICATIONS FOR REHABILITATION Cardiopulmonary exercise testing is a real-time predictor of functional capacity and thus is used as a pre-operative tool to measure physiological fitness and predict outcomes. Renal failure is associated with exercise intolerance and transplantation is transformational in terms of quality of life, longevity and healthcare cost. Live–related renal donation is increasingly available but whether donation itself carries a long-term health burden has not been previously well established. This study suggests that renal donation is not associated with long-term cardiopulmonary compromise and patients who donate their kidneys recover their previous fitness within 14 weeks.

Journal Article Type Article
Journal Disability and Rehabilitation
Print ISSN 0963-8288
Electronic ISSN 1464-5165
Publisher Taylor & Francis
Peer Reviewed Peer Reviewed
APA6 Citation Angell, J., Dodds, N., Darweish-Mednuik, A. M., Lewis, S., Pyke, M., Mitchell, D. C., …Tolchard, S. (in press). Characterising recovery from renal transplantation and live-related donation using cardiopulmonary exercise testing. Disability and Rehabilitation, https://doi.org/10.1080/09638288.2019.1674387
DOI https://doi.org/10.1080/09638288.2019.1674387
Keywords Kidney donors; Post-operative; Fitness; Kidney failure; Physiological burden