FP740PREHABILITATION BEFORE RENAL TRANSPLANTATION

Abstract

Introduction and Aims: End-stage renal disease (ESRD)isoften associated with impaired physical function (PF) and low aerobic capacities, strong risks factors for cardiovascular disease and mortality. Poor PF is associated with an increased risk of post-transplant complications. This underlines the need to improve functional capacities before renal transplantation. Since 2010, renal transplant candidates with poor PF in our center have been addressed for prehabilitation. The objective of this study was to evaluate the benefit of an exercise-based program in an ESRD population undergoing renal transplantation on their aerobic capacities, their access to a kidney graft and the post-transplant outcomes. Methods: This retrospective and multicenter study included ESRD patients having benefited from the rehabilitation program between May 2010 and December 2015 in the North of France. Enrolled patients underwent 20 outpatient supervised exercise sessions (3 times a week) on the non-dialysis days. The patients' aerobic capacity was evaluated by cardiopulmonary exercise testing, measurement of the peak oxygen uptake (VO2 peak) and a six minute walk test. Main clinical and laboratory data (pre-trans-plant consultation, program data and post-transplant outcomes) was collected. Results: Forty-seven patients achieved the exercise program. Patients were mostly women (70%) with a median age of 58 years. They significantly improved their VO2 peak (12.42 6 3.95 ml/kg/min to 14.74 6 3.84 ml/kg/min, p = 0.009) and the six minute walk distance (405 6 101 meters to 482 6 104 meters, p < 0.001) during the prehabilitation. No significant differences were observed in mean body weight nor in body mass index (BMI). Twenty-eight (59.6%) renal transplant recipients were evaluated. A multivariate analysis showed that a history of hypertension was associated with better kidney graft access (HR = 4.57 [1.72-12.15], p = 0.002). Diabetes (HR = 0.37 [0.15-0.95], p = 0.038) and BMI (HR = 0.87 [0.79-0.96], p = 0.007] were associated with poor transplant access. Four patients had post-operative complications. One year after transplantation, thirteen patients had at least one infection and thirteen patients needed hospital readmission. Univariate analysis showed that age was associated with a higher risk of rehospitalizations (OR = 1.78 [1.01-3.09], p = 0.046) while VO2 peak gain was associated with a risk reduction of rehospitalizations (OR = 0.65 [0.39-0.96], p = 0.05). VO2 peak gain was also associated with a risk reduction of infection (OR = 0.64 [0.37-0.95], p = 0.056). Conclusions: Exercise therapy before renal transplantation significantly improves ESRD patients' aerobic capacities. This kind of program allows access to kidney transplantation to patients with reduced fitness. Improving aerobic capacities reduces the risk of infection and rehospitalization one year after transplantation. To our knowledge, we report the first investigation studying about an exercise-based program before kidney transplant and its post-transplantation outcomes.