The cardiorespiratory capacity of Hungarian National Transplant
Team related to their sport performances on the 2011 Göteborg
World Transplant Games
Trájer, E1, Tóth, Sz1, Komka, Zs1, Bosnyák, E1, Kováts, T1, Udvardy, A1, Protzner, A1, Szakály, D1, Székely, Gy2, Tóth, M1
1.
Seemmelweis University, Budapest
2. Hungarian Transplant Federation, Budapest
INTRODUCTION
RESULTS I.
The Hungarian Transplant Team (with 46 participants)
won 89 medals at the World Transplant Games in
Göteborg, 2011 .
The low availability of donor organs put a claim on the
long-term successful transplantations. The physical
capability is a useful method to measure the quality of
life.
The cardiorespiratory capacity provides background
for the metabolic changes.
The maximal oxygen uptake (VO2max) is an optional
measurement to assess liver or renal transplant
patients.1 Also, it provides an objective tool for the
measurement of the functional capacity of
posttransplant patients. Exercise limitation and loss of
aerobic capacity are common among patients with
chronic illness or with end-stage liver disease.2
Cardiopulmonary exercise testing (CPET) has become
an important clinical tool to evaluate exercise capacity
and predict outcome in patients with heart failure and
other cardiac conditions. The peak oxygen uptake
(VO2max) and the oxygen pulse (O2p) could be predictive
in the long-term graft survival.3-4
Our aim was to determine the cardiorespiratory
capacity of the athletes participating in the 2011 World
Transplant Games in the aspects of the athletic
performance.
RESULTS II.
Baseline demographics of
transplanted athletes
female
Number of participants (n)
11
14
Age of participants (years)
37.3 18.4
41.2 13.6
Kidney
9
12
Liver
2
2
Maximal test on treadmill
11
Country
male
14
Ischemic heart failure
0
0
Hypertension
2
8
Diabetes mellitus
1
0
Smokers
0
4
Gold
Silver
Bronze
Score
1.United Kingdom
115
95
77
612
2.United States
47
38
27
244
3.Australia
41
28
32
211
4.Hungary
5.Iran
6.Germany
33
23
23
21
15
12
35
18
5
176
117
98
7.Netherlands
22
17
18
118
8.Argentina
21
15
11
104
9.South Africa
15
16
13
90
10.China
14
7
7
63
Table 4: The Hungarian Team reached the fourth place on the
medals table from the total 54 countries at WTG in Göteborg, 2011.
Table 1.:Baseline demographics of the 25 transplanted athletes participated in our study.
Transplantation
female
male
primer
11
14
Transplanted athletes
Age
Graft ages after operation
(year)
11.74 5.8
Kidney
11.56 5.6
Liver
9.58 7
10 9.8
8 1.4
Male
Female
Age
Male
Female
36.51
35.00
10-19
47-56
38-46
30.00
52.2*
20-29
43-52
33-42
37.80
55.1*
30-39
39-48
30-38
47.70
44.7*
40-49
36-44
26-35
-
54.2*
50-59
34-41
24-33
22.10
-
60-69
31-38
22-30
10-19
n=3/1
9.36 8
Healthy non-athletes
population (4)
20-29
n=2/3
30-39
Spirometry results
IVCmax/pred (%)
FEV1/IVC
n=1/1
84 16
89 32
81 16
94 37
40-49
n=3/6
50-59
MEF50 (%)
94 42
103 31
Table 2.: Baseline data of ransplantation and graft ages.
Functional exercise indicator parameters during incremental treadmill test.
n=5
60-69
n=2
Table 5-6: * VO2max of transplanted athletes >110% of VO2 max of healthy non-athletes
population
METHODS
Twenty-five liver and kidney transplant athletes (11
women, 14 men; age: 39.3±15) were examined. Maximal
cardiorespiratory capacity was measured with a vita
maxima test, using modified Bruce protocol on treadmill
(Schiller AT-104).
Before the exercise test echocardiography, 12-lead
ECG, graft-specified venous blood test were performed.
Static and dinamic spiroergometric parameters were
recorded at rest. During the ergospirometry test we
continually registered heart rate (HR) with a 12-lead ECG
system, and used a breath-by-breath gas analyzer
(Ganshorn PowerCube-Ergo system) to measure
respiration parameters (VO2, VCO2, VE, RQ). Anaerobic
threshold (AT) was also registered. In the restitution
phase, heart rate and blood pressure were documented.
Blood test parameters
female
male
Number of participants (n)
11
14
Before
OLT
Liver
112.3 40.7
75.5 12
134.5 32.2
103 12.7
Bilirubin (mmol/l)
Kidney
Liver
1.48 3.9
8.74 2.9
9.4 7.9
8.8 3.3
15.37 6.5
VO2max-rel
(ml/kg/min)
1.64 5.34
n=38
Creatinine (μmol/l)
Before RTX
VO2max (l/min)
M. Iscar et al.
(2009)
Kidney
12 months
after OLT
M.Lemyze et al.
(2009)
n=20
age: 54 4.5 (year)
1.47 0.08
Ru-Lan Hsieh et al.
(2006)
n=54;
age: 60.6 9.2 (year)
Koufaki et al. (2002)
11.5 2.9
19.5 4.7
n=15
age: 50.5 (year)
VO2max-rel (ml/kg/min)
S. Dharancy et al.
(2008)
n=135
age: 52 (year)
Lennon DL et al.
(1986)
17.2 4.4
18.5 5.9
n=10
Table 7.: Maximal Oxygen Uptake (VO2max) before and after transplantation in
the international literature.
Immunosupression
Tacrolimus
7
10
Cyclosporin
3
3
Sirolimus
1
1
CPET results
Wmax
Table 3.: Blood test parameters and Immunosuppression types
Female
202.3±48.1
Male
319.25±80.9
Total
Cohort
271.6±90
WAT
130.6±27.9
179.25±60.2
159.4±54.6
Wmax/Wpred
139.3±37.6
146.±34.4
143.9±36.2
METmax
11.8±4
14.7±4
13.5±4
Total time (sec)
439±119
650±142
561±168
Aerob capacity, sport performance and quality of life are highly related to each other. Good graft function after
successful solid organ transplantation provides the base for cardiopulmonary exercise capacity.
HRMAX (1/beat)
174.4±23.3
176.81±19.8
176±20.9
HRAT(1/beat)
106.3±22.2
106.3±16
106.3±17.9
High cardiorespiratory capacity providing proper graft oxygenation is an important factor in long-term graft
survival. Cardiorespiratory capacity is highly connected to physical activity and strongly related to sport performance.
HRAT/HRmax (%)
82.6±83.2
74.7±74.8
77.9±78.26
VO2max-rel
31±8.8
39.8±10.6
36.2±10.7
The excellent spiroergometric performance of the athletes contributed to their outstanding sport results in the
2011 World Transplant Games. Objective, functional data (VO2max, O2p) from the spiroergometry test might be used in
the prediction of long-term graft survival and used for sport program recommendation for transplanted patients.
However, this requires further studies.
VO2AT-rel
23.2±5.03
22.8±8.8
22.9±7.4
O2pulsemax(ml/beat)
10.90±1.9
17.21±3.5
14.64±4.3
O2pulsemax/
O2pulsepred (%)
115.17±22.6
114.41±22.6
114.72±22.2
RERmax
1.26 ±0.1
1.26±0.1
1.3±0.1
BPsys-max (Hgmm)
167±17
176±21
173±20
Bpdias-max(Hgmm)
86±7.2
82±15.7
83±12.9
CONCLUSION
The lack of long-term longitudinal studies of transplanted athletes compared to non-athletes complicate to
estimate the impact of regular physical exercise on the graft survival range.
References:
(1) Patricia Painter: Physical functioning in end-stage renal disease patients: Update 2005; Hemodialysis International 2005; 9: 218–235
(2) Sebastien Dharancy et al.: Impact of Impaired Aerobic Capacity on Liver Transplant Candidates; Transplantation 2008;86: 1077–1083
(3) Malcolm Lemyze et al.: Aerobic capacity in patients with chronic liver disease: Very modest effect of liver transplantation; Presse Med. 2010, 39: e174-e181
(4) M. Iscar et al.:Functional Capacity Before and After Liver Transplantation; Transplantation Proceedings, 41, 1014-1015, 2009
(5) H. Wilmore et al.: Physiology of Sport and Exercise, 2005
Table 8.: Exercise indicators during incremental treadmill test.
Email: [email protected]
TÁMOP.4.2.1.B-09/1/KMR-2010-0001