Rehabilitation after cardiac transplantation. Case series and literature review

Twelve heart transplant recipients were admitted to the rehabilitation unit (RU) of a tertiary general hospital during a five-year period. Demographic, medical, and functional data were collected on these patients in a prospective and retrospective chart review. Functional status of each patient was assessed at both admission and discharge by means of the Modified Barthel Index (MBI). All transplant patients admitted to the RU were male, with an average age of 58 (range, 48-64) years. The mean MBI at admission was 57 (range, 31-75), and mean MBI at discharge was 86.5 (range, 55-100). The difference between the mean MBI admission score and that at discharge was demonstrated to be statistically significant (P < 0.001) using the paired t test. The average length of stay on the RU for the 12 patient cohort was 26 (range, 10-63) days. Ten of the 12 patients (83%) were discharged from the RU to the community. Two patients had to be transferred back to the acute care units after developing significant medical problems. Of the patients who returned to the community, the average number of medications at discharge was nine (range, 7-13), with all patients taking prednisone and cyclosporine. At the time of admission, all patients presented with numerous secondary medical problems. Six patients (50%) had hypertension, which required a medical regimen for control. Five patients had either inadequate oral intake or swallowing problems, thus requiring a feeding tube. In four of the five patients, the feeding tube was able to be removed during the RU course. Seven patients had associated neuromuscular deficits, which included hemiparesis (2 patients), paraparesis (1 patient), and myopathy (1 patient). Four patients were found to have pressure sores on admission to the RU, three of whom were completely healed by the time of discharge. Two of the patients had affective disorders that required follow-up by the psychiatry service during their stay on the RU. One patient was found to have radiographic evidence of a vertebral compression fracture but no other recipients had known fractures, osteoporosis, or osteopenia. As well as discussing the above data, the authors will also review basic exercise guidelines for cardiac transplantation patients.