Cardiac rehabilitation in a pediatric patient with heart retransplantation

Background. Cardiac rehabilitation (CR) after heart transplantation is known to benefit physical capacity in adults, but the advantages of CR on pediatric patients with heart retransplantation remain undetermined. Aim. The purpose of the present study was to report the effect of structured CR for a boy receiving heart transplantations twice. Design. Single case study. Setting. Inpatient and outpatient rehabilitation department Population. A pediatric patient underwent heart transplantation due to dilated cardiomyopathy at 13.6 year-old and retransplantation owing to severe cardiac allograft vasculopathy at 16.2 year-old. Methods. CR was arranged after both transplantations. Bicycle or treadmill exercises were conducted three times weekly with the intensity adjusted to the ventilatory threshold. Serial cardiopulmonary exercise tests were performed to evaluate the sequential cardiorespiratory function changes using the peak oxygen uptake (VO_2peak) as the primary outcome. Results. The patient had undergone 10 times of exercise tests during rehabilitation. The VO_2peak increased from 12.27 to 15.63 mL.kg ^-1.mhr^-1 within 6 months after the primary transplantation. However, the VO_2peakdropped intensively after a rejection episode and failed to improve since the development of cardiac allograft vasculopathy. Following retransplantation, the VO _2peak appeared worse initially but increased gradually with rehabilitation. One year subsequent to retransplantation, the VO_2peak reached 17.7 mL.kg ^-1.min^-1 with a 7.22 mL.kg^-1.mhr^-1 improvement compared with his baseline value. Conclusion. Structured CR improves aerobic capacity of a pediatric patient with heart retransplantation. Clinical Rehabilitation Impact. CR is safe and beneficial for pediatrics with heart retransplantation. Cardiopulmonary exercise testing can be considered as an adjuvant tool for detecting rejection or cardiac allograft vasculopathy in pediatric heart transplantation recipients.