Upper Limits of Aerobic Power and Performance in Heart Transplant Recipients
Legacy Effect of Prior Endurance Training
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
December 3, 2017, marked the 50th anniversary of the first human-to- human heart transplant (HT) surgery, performed by Dr Christiaan Barnard at the Groote Schuur Hospital in Capetown, South Africa. Since this seminal operation, >124 000 HTs have been performed, and the survival rate has improved significantly (current median survival: 11.9 years) as a result of refinements in donor and recipient selection, advances in surgical techniques, organ preservation strategies, and immunosuppressive therapy.
Despite improvement or normalization of left ventricular systolic function, HT recipients (HTRs) typically have a peak aerobic power (peak Vo2) that is ≈40% lower than age- and activity-matched healthy people.1 Persistent impairment of peak Vo2 following HT is multifactorial with contributions from abnormal skeletal muscle function associated with pre-HT heart failure (HF), bedrest deconditioning associated with prolonged hospitalization, posttransplant cardiac allograft denervation, and immunosuppression therapy.1
Although short-term (<12 months) exercise training among HTRs is an effective therapy to increase exercise capacity, peak Vo2 typically remains ≈20% lower than values seen in healthy, normally active, age-matched people. However, not all HTRs remain permanently impaired, and mounting experience suggests that some patients are capable of performing high levels of physical activity following HT. We previously reported the athletic ability of a man who was normally active before the development of nonischemic cardiomyopathy, underwent successful HT at age 26, and then began performing moderate- to high-intensity endurance exercise training 18 years post-HT (45 …