Answer: The availability of massage treatments as well as facilities offering services such as tanning have grown throughout the United States along with the increased number of patients who have been treated with organ transplants. Massage and tanning practices may vary from place to place, and in some cases may even be available in the home. So, the question of using such services after an organ transplant may be on the minds of many patients and families.

Many massage therapists are fully trained and licensed by regulatory agencies. As with most occupations, the experience of any individual massage therapist may differ greatly from others, and one cannot know the expertise a particular individual would bring to a massage session. The licensed professional, however, should be aware that the person on the massage table is a transplant recipient and such information should be obtained from the transplant patient through a brief discussion of medical history before the session begins. The transplant patient should be aware that there may be a significant difference between an organ recipient and others that the massage therapist ordinarily sees.  And, there may be reasons to not go forward depending upon a host of circumstances, including the presence of relatively fresh surgical incisions, complicating illnesses which many transplant patients experience, or other factors.

Generally, however, most transplant patients find massage therapy to be a positive experience. Many persons enjoy such sessions at spa resorts, fitness clubs and even in the home (a family friend of the author makes house calls as a licensed massage therapist). Transplantation patients should be able to enjoy such a service if so inclined. Obviously, the routine features of cleanliness, gentle technique and empathetic management of the massage session should all be characteristic of any licensed massage therapist.

Special cautions may be worth noting. For example, a small number of transplant recipients have bone and joint problems (such as hip degeneration) related to medication or disease. In its early stages, such problems may cause knee pain or thigh discomfort and the patient may feel as though massage treatment is indicated for relief. Similarly, some transplant recipients with a history of osteoporosis might get some relief of symptoms through massage therapy. Any such relief is not permanent however and the transplant team should treat recurring symptoms. Certain patients on immunosuppressive drugs have significant skin changes and are subject to peeling of very thin skin and easy bruising. In such circumstances, the massage therapist may not want to initiate the session. In any case where massage therapy seems unsuccessful, the patient should seek advice from the transplant team.

Tanning beds may pose a significant problem to the transplant recipient. While there may be standards regarding the manufacture and use of tanning beds, the overall advice to patients taking immunosuppressant medications is to avoid exposure to the sun because of skin cancer risk. The response of our skin to light energy which causes the skin to darken (tanning) is similar in the circumstances of direct sunlight and exposure to light energy on the tanning bed. According to some dermatologists, light energy in some tanning beds may even be more dangerous than direct sunlight. Furthermore, the thought that becoming tan by using a tanning bed prior to a period of sun exposure to prevent sunburn seems illogical and dangerous at best, especially since virtually all transplant recipients should heed the advice to limit their time in the sun.

For many years, transplant professionals have recommended that patients wear broad brimmed hats, long-sleeved shirts and other attire that cover the majority of the skin to prevent sun exposure in outdoor recreation. This advice might also be good for persons who are not immunosuppressed and at special risk for cancers. Dermatologists are increasingly aware that many patients are at high risk for skin cancers and that risk increases with increasing sun exposure and with similar light exposure as well. Therefore, it is probably best to think twice about the beauty of a tan.

The enjoyment of normal activities is one of the great blessings of a functioning organ transplant and patients should be encouraged to pursue active lifestyles to the fullest extent possible.  Therefore, enjoying a professionally rendered massage may be fine for most. And enjoying outdoor activities with ample use of sunscreen and proper head cover and clothing also should be encouraged. We should not, however, encourage treatment or activity, which might mask signs or symptoms of genuine difficulty or harm the transplant recipient. Tanning beds and sun exposure are best omitted from the activities of organ transplant recipients.

Answer provided by Thomas G. Peters, MD, FACS. 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 and the AAKP Board of Directors.

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, September 2002 Volume 18 Number 2. 

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