Should Transplant Recipients Participating in the World Transplant Games have Cardiac Stress Testing before Being Able to Participate

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The World Transplant Games is a biennial, multi-sports, seven day event for transplant athletes from over 50 counties and is a major opportunity to promote the fantastic benefit of the gift of life by organ donors. The resulting international sporting competition amongst transplant recipients with a full range of sporting ability is a visual demonstration of the life changing impact of organ transplantation. Transplant recipients have increased risk of cardiovascular events over the general population. A medical questionnaire is completed by all participants and their registered transplant clinician with the current stipulation that all participants aged over 40 should undergo a cardiac stress test and have no evidence of ischaemic changes on exercise. Participants have the alternative option of completing a disclaimer instead of the stress test.This study aimed to analyse the demographics, transplant type and fuction, blood pressure control, cardiac stress test uptake and results and outcome of participants of the Great Britain (GB) and Northern Ireland (NI) Transplant team at the 2017 World Transplant Games in Malaga, Spain. All medical questionnaires were reviewed by 2 clinical researchers.The GB and NI team comprised 174 competitors median age 43 (14-82) years with 99 (57%) aged over 40. 57.5% were male; 95 (55%) renal, 42 (24%) liver, 15 ((9%) bone marrow, 14 (8%) heart, 4 (2%) lung, 2 (1%) small bowel and 2 (1%) pancreas recipients. Transplant function was good with median serum creatinine 105 (63-277) umol/L; serum haemoglobin 135 (92-157) g/dl; bilirubin 10 (5-48) umol/L; tacrolimus level 5 (1-10.5) ng/dl. Median blood pressure 128/78 (92-158 systolic / 63-94 diastolic). Only 2/99 (2%) aged over 40 had an exercise stress test which both revealed good exercise capacity Bruce protocol >10 minutes without ischaemic changes. This included 1/14 heart transplant recipients; 13/14 heart recipients were deemed fit to participate by their transplant cardiologists on the basis of routine standard clinical monitoring. The remaining 97/99 (98%) signed a disclaimer. 76% participated in high intensity sports such as athletics; swimming; squash; cycling; badminton and tennis. There were no cardiac events / hospitalisations amongst the team members.These results confirm the safe participation of a relatively old median age of GB and NI competitors in the World Transplant Games despite minimal uptake of recommended cardiac stress test assessments. This analysis suggests that it is not necessary to perform cardiac screening tests in transplant athletes prior to participation in the World Transplant Games.World Transplant Games Federation.

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