Exploring the State of the Science of Solid Organ Transplantation and Disability Proceedings of a Workshop (2021) / Chapter Skim
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5 Treatments, Technologies, and Interventions Affecting Function After Transplantation
5 Treatments, Technologies, and Interventions Affecting Function After Transplantation
Pages 63-76
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From page 63... ...
Speakers described the pharmacologic treatments and their side effects following transplantation and described the standard and emerging practices to support and improve health and functioning, including prehabilitation, posttransplant rehabilitation, and palliative care. The last section highlights the panel discussion, including salient questions asked by attendees from SSA, and suggestions from individual speakers for taking these approaches to the next level.
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From page 64... ...
Because patients often experience a variety of other challenges following the procedure, they may find it easier to modify their daily routine prior to the transplant. She added that many patients have prolonged recovery and may be rehospitalized in FIGURE 5-1 Three components of the strength training interventions for liver transplant patients based on the Information-Motivation-Behavioral Skills conception model for modifying individual health behaviors.
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From page 65... ...
She said that while the pretransplant period is an ideal window to recruit patients into efforts to modify their behavior that will benefit overall health following transplantation, the challenge is that there are only two studies of transplant candidates (lung and kidney, respectively) showing that prehabilitation can affect posttransplant outcomes.
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From page 66... ...
Patients are also often on antibiotics or antiviral medications, which can cause nausea and diarrhea. Transplant recipients need to take immunosuppressive medications for life to prevent organ rejection, but these medications can often cause neurological symptoms that may affect physical and cognitive functioning.
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From page 67... ...
While it was a small study, he showed that many of the functioning measures all improved in 8 weeks just by changing the route of administration, demonstrating how small changes in treatment FIGURE 5-2 Brain function and metabolism in patients with long-term tacrolimus therapy after kidney transplantation compared to patients after liver transplantation and healthy controls. NOTE: HC = healthy control; KT1 = 1 year post-kidney transplantation; KT5 = 5 years post-kidney transplantation; KT10 = 10 years post-kidney transplantation; LT = liver transplantation.
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From page 68... ...
The goals of posttransplant rehabilitation are multifaceted and thus require a multidisciplinary approach. Beyond physical functioning, rehabilitation goals can also include improving treatment adherence, addressing sleep quality, addressing mental health issues, and providing social support, such as a peer network for the recipient and their family.
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From page 69... ...
Her team recently published a systematic review and meta-analysis on the effects of exercise training across solid-organ transplant groups. They found great improvements across all organ types seen in aerobic exercise capacity, such as leg muscle strength and QOL, all resulting from regular exercise training (Janaudis-Ferreira et al., 2021)
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From page 70... ...
She suggested disseminating evidence-based guidelines and the evidence of benefits to both physicians and patients of various rehabilitation programs. PALLIATIVE CARE To give a better understanding of palliative care, Kirsten Wentlandt of the Ajmera Transplant Centre at the University Health Network in Toronto provided a definition from the World Health Organization (see Box 5-1)
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From page 71... ...
Care coordination: decreased emergency room visits, decreased hospital admissions, improved lengths of stay, decreased ICU care, and decreased health care costs SOURCES: Kirsten Wentlandt presentation, March 23, 2021; Bajwah et al., 2020; Gonzalez-Jaramillo et al., 2020; Quinn et al., 2020.
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From page 72... ...
Other benefits were decreased emergency room visits and hospital admissions, decreased length of hospital stays and ICU care, and reduced health care and end-of-life hospitalization costs. Much of this work stems from research in cancer populations, she explained, but the past decade has seen an integration of palliative care into other populations (Quinn et al., 2020)
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From page 73... ...
She said these patients may have benefited from a targeted conversation to understand whether this type of care was what they really wanted. She argued for a more thoughtful approach to palliative care integration in transplant populations, especially knowing now that these patients are very unlikely to receive this care without transplant programs taking proactive steps to remedy this.
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From page 74... ...
Mathur used her transplant center's experience as an example and said they have a mandatory pretransplant rehabilitation program for all lung transplant candidates. Mathur noted that this is an excellent program but is not indicative of standard practices across all transplant centers.
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From page 75... ...
McAdams-DeMarco acknowledged there is a need to define the ideal prehabilitation program for each of the solid organ transplant candidates that can be customized for individuals. She suggested this could be done through research and quality improvement efforts.
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