Answer: A return to all physical activities following major surgery is the goal for patient and surgeon alike.  Patients want to resume the usual activities of daily living such as employment, recreation and routine tasks.  Surgeons know that patients recover best when they are physically active. Increasing physical activity as time goes on prevents or diminishes the risk for many postoperative complications.  This is as true with kidney transplantation as it is with other aspects of surgical care. Most surgeons doing kidney transplants today delight when their patients demonstrate progressive and even vigorous physical activities as time passes from the operation itself.

Kidney transplant surgery usually involves placing the new organ in a small abdominal pocket adjacent to the groin.  The kidney can be placed on either the right side or the left side, and the incision through which the surgery is done often times is within the bikini line.  Most surgeons today close the operative incision with a plastic surgery technique or with simple skin staples or sutures.  If the staples or sutures are used, they usually can be removed within one to two weeks following surgery.  This type of incision, similar to a classical hernia repair incision (but a bit longer), usually takes between two to four weeks to heal entirely.  The inside portions of the incision where the muscles are divided and then sewn together at the completion of surgery usually takes between four to six weeks to heal entirely.  Because of the area of the incision, the strain of vigorous physical activity on the abdominal muscles and skin, and the similarity to groin hernia situations, surgeons have generally advised transplant patients about physical activity much as they have advised patients with classical groin hernia repair.

The advice regarding physical activity ordinarily includes a warning about lifting heavy objects for the first four to six post-operative weeks.  We often advise patients that they should lift nothing heavier than an ordinary desk telephone in each hand for the first four to six weeks.  This means that simple recreational activities, such as walking, can be part of early physical rehabilitation.  More vigorous outside activities require some straining of the abdominal muscles and should be avoided for four to six weeks after the surgery. 

For the patient who has recovered from kidney transplantation, outside recreational activities should be undertaken with considerations to other health and physical circumstances.  The range in age of newly operated transplant recipients now spans from infancy to age 80 or more, and all who have a successful transplant should be encouraged to enjoy the outdoors.  Should other health problems not be present, most patients can plan the type of recreation they enjoy.  I usually recommend that vigorous contact sports (such as football, ice hockey and basketball) be avoided.  That does not mean, however, that these games cannot be enjoyed.  It is the vigor of contact and the possibility that groin injury could affect the kidney, which we tend to warn patients against.  Furthermore, I believe that activities such as parachuting and bungee jumping should be considered carefully prior to participation since parachute harnesses and strains on the abdominal muscles may prove harmful in some patients.

What is the ideal outside physical activity for the transplant patient?  The answer to this question is somewhat elusive since we all have various interests and wishes regarding outside recreation.  In looking at our own transplant patient population, we have a wide variety of interests and activities.  Some enjoy the boating and water sports so readily available in Florida; others prefer fishing and hunting, which is also a part of the outdoor scene in this area.  Obviously, the vigor with which one approaches these activities can vary considerably.  Patients also participate in golf, tennis, basketball and other outdoor games.

One cautionary note regarding outside activities and transplant patients concerns sun exposure.  The various medications required to prevent rejection also make transplant patients susceptible to skin cancers.  The trend toward skin cancer is made worse by sun exposure.  Therefore, it is wise for transplant recipients who spend time in the outdoors to wear broad brimmed hats and use an effective sunscreen.  Finding shady areas around the pool or at the beach may also protect patients from sun exposure, and therefore lessen the likelihood that skin cancer will develop.  Because skin malignancy is both dangerous and unsightly, all patients on immunosuppressive medications should avoid purposeful overexposure to the sun.  In fact, a wardrobe of very light-weight summer clothing (but with long sleeve shirts and slacks instead of short sleeved shirts and shorts) can be a simple part of staying healthy and enjoying the outdoors.

Kidney transplant recipients often consider their lives renewed.  Such a renewal should be accompanied by the best overall physical rehabilitation possible, preferably one in which the patient enjoys independence, self-care and ample recreation.  Outside recreation is, most would agree, one of life's "tonics," and brings the added dimension of improved physical conditioning and stress management to many.  Certainly, safety measures such as sunscreen, appropriate clothing and common sense applied to all daily activities will add up to a healthy and hopefully long-term transplant course.

Answer provided by Thomas Peters, MD. Dr. Peters is the Director at the Jacksonville Transplant Center at Shands Jacksonville. He is also a Clinical Professor of Surgery at the University of Florida Health Science Center/Jacksonville. Dr. Peters also serves as a member of AAKP's Medical Advisory Board.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in aakpRENALIFE, Volume 16 Number 1, July 2000

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